Einfluss oraler Antidiabetika auf Knochenstoffwechsel und Frakturrisiko

C. Traechslin; J. Vavanikunnel; M. Kraenzlin; C. Meier

doi:10.1055/s-0038-1636976

Osteologie, Table of Contents

Osteologie 2018; 27(01): 29-37
DOI: 10.1055/s-0038-1636976

Therapieinduzierte Osteoporose – Treatment-induced osteoporosis

Schattauer GmbH

Einfluss oraler Antidiabetika auf Knochenstoffwechsel und Frakturrisiko

Effects of diabetes drugs on bone metabolism and fracture risk

C. Traechslin

¹Klinik für Endokrinologie, Diabetologie und Metabolismus, Universitätsspital, Basel, Schweiz

,

J. Vavanikunnel

¹Klinik für Endokrinologie, Diabetologie und Metabolismus, Universitätsspital, Basel, Schweiz

,

M. Kraenzlin

²Endonet, Endokrinologische Praxis & Labor, Basel, Schweiz

,

C. Meier

¹Klinik für Endokrinologie, Diabetologie und Metabolismus, Universitätsspital, Basel, Schweiz

²Endonet, Endokrinologische Praxis & Labor, Basel, Schweiz

› Author Affiliations

Abstract

Zusammenfassung

Der Einsatz von oralen Antidiabetika ist in der Behandlung von Patienten mit Diabetes mellitus Typ 2 unverzichtbar. Durch eine verbesserte Blutzuckereinstellung werden mikro- und makrovaskuläre Spätkomplikationen verhindert. In den vergangenen Jahren haben wir die Erkenntnis gewonnen, dass die Diabeteserkrankung auch mit metabolischen Knochenveränderungen und Frakturen assoziiert ist. Die Pathogenese der diabetischen Knochenerkrankung ist multifaktoriell, mikrovaskuläre Veränderungen im Knochenmilieu und morphologische Veränderungen der skelettalen Mikroarchitektur werden als ursächliche Mechanismen diskutiert. Einige orale Antidiabetika üben einen Einfluss auf den Knochenstoffwechsel aus und können dadurch das Frakturrisiko mitbeeinflussen. In diesem Artikel werden Wirkweisen oraler Antidiabetika und deren Enfluss auf den Knochenmetabolismus zusammengefasst. Während Thiazolidinedione einen ungünstigen Effekt auf den Knochen ausüben, scheinen sich Metformin und inkretinbasierte Therapien eher protektiv oder zumindest neutral auf den Knochenstoffwechsel auszuwirken. Sulfonylharnstoff sind aufgrund ihres Hypoglykämierisikos mit Auftreten von sturzbedingten Frakturen assoziiert. Die Datenlage betreffend der seit Kurzem zur Verfügung stehenden SGLT-2-Inhibitoren ist unklar, insbesondere bei älteren Patienten mit längerer Diabetesdauer und eingeschränkter Nierenfunktion scheint eine erhöhte Sturz- und Frakturgefährdung aufgrund von Veränderungen des Flüssigkeitshaushaltes und des Körpergewichtes vorzuliegen. Entsprechend ist im klinischen Alltag in der Wahl eines Antidiabetikums auch dem individuellen Frakturrisiko Rechnung zu tragen.

Summary

The use of oral antidiabetic drugs is essential in the treatment of patients with type 2 diabetes. Recently it has been recognized that type 2 diabetes is associated with changes in bone metabolism and fractures. The pathogenesis of diabetic bone disease is multifactorial with microvascular changes and deterioration of skeletal microarchitecture being discussed as underlying mechanisms. Oral antidiabetic drugs may affect bone metabolism and thereby may modulate fracture risk. This article summarizes the mode of action of oral antidiabetic drugs and their influence on bone metabolism. While thiazolidinediones are known to be deleterious on bone with increased fracture risk in longterm users, metformin and incretin-based therapies appear to have a protective or at least neutral effect on skeletal integrity. Sulfonylureas are associated with fall-related fractures due to an increased risk of hypoglycemia. The data regarding the recently available SGLT-2 inhibitors is unclear, specifically in older patients with longstanding diabetes and renal impairment there seems to be an increased fall and fracture risk due to changes in fluid balance and body weight. In clinical practice the individual fracture risk has to be considered when choosing an oral antidiabetic medication.

Schlüsselwörter

Diabetes mellitus Typ 2 - TZDs - Metformin - Inkretin - DPP-4-Inhibitoren - SGLT2-Inhibitoren - Frakturen

Keywords

Type 2 diabetes - TZDs - metformin - incretins - DPP-4 inhibitors - SGLT2 inhibitors - fracture

Full Text

References

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