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Diabetes und Osteoporose

Pathophysiologische Interaktionen und klinische Bedeutung für geriatrische Patienten

Diabetes and osteoporosis

Pathophysiological interactions and clinical importance for geriatric patients

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Zusammenfassung

Die Osteoporose ist eine altersassoziierte Erkrankung, die zu einer verminderten Knochenfestigkeit und einem erhöhten Frakturrisiko führt. Patienten mit einem Typ-2-Diabetes mellitus zeigen trotz einer normalen oder sogar gesteigerten Knochendichte ein erhöhtes Frakturrisiko, das auf ein Missverhältnis zwischen der osteoblastären Knochenneubildung und dem Knochenabbau durch Osteoklasten zurückgeführt wird. Komplexe pathophysiologische Mechanismen in Folge der Insulinresistenz und der Hyperglykämie liegen diesen Veränderungen zugrunde. Diskutiert wird auch ein möglicher Einfluss der Qualität und Form der antidiabetischen Therapie auf das Frakturrisiko. Für die klinische Praxis von Bedeutung ist die Beurteilung des Sturzrisikos, das bei Patienten mit Diabetes aufgrund diabetischer Spätkomplikationen, wie der Neuropathie, aber auch infolge von Nebenwirkungen der medikamentösen Therapie gegenüber einer nichtdiabetischen Vergleichspopulation erhöht ist. Lebensstilmaßnahmen stellen die Basisintervention in der Prävention und Therapie des Diabetes mellitus wie auch der Osteoporose dar. Die Supplementierung mit Vitamin D zeigt neben den präventiven Effekten auf das Sturz- und Frakturrisiko eine günstige Einflussnahme auf die Insulinsensitivität. Die Effektivität und Sicherheit spezifischer Formen der Osteoporosetherapie (Bisphosphonate, Denosumab, selektive Östrogenrezeptormodulatoren) zeigt entsprechend der vorliegenden Daten aus der Literatur keinen Unterschied zwischen Patienten mit und ohne Diabetes mellitus.

Abstract

Osteoporosis is an age-associated disease, resulting in impaired bone quality and increased risk for bone fractures. Patients with type 2 diabetes mellitus have—despite a normal or even increased bone mineral density—an increased risk for fractures, which is related to an imbalance between osteoblastic bone formation and osteoclastic resorption. Complex pathophysiological mechanisms associated with insulin resistance and hyperglycemia are involved in the deleterious effects on osteoblast function and bone formation. The quality and regimen of antidiabetic therapy are discussed as modulators of bone metabolism. Of great clinical importance is an assessment of the fall risk especially for diabetic patients, because late complications, such as neuropathy, but also side effects of medication can result in a significantly increased risk for falls. Lifestyle intervention is of advantage with respect to diabetes and osteoporosis prevention and therapy. Vitamin D supplementation results in favorable effects with a reduced risk for falls and also improvements of insulin sensitivity. According to published data, the safety and efficacy of specific medication for the treatment of osteoporosis (bisphosphonates, denosumab, selective estrogen receptor modulators) reveal no difference between patients with and without diabetes mellitus.

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  1. Abteilung für Innere Medizin, Landeskrankenhaus Hochzirl, Anna-Dengel Haus, 6170, Zirl, Österreich

    M. Lechleitner MD

  2. Institut für Physikalische Medizin und Rehabilitation, SMZ Sophienspital, Wien, Österreich

    K. Pils

  3. Abteilung für Angiologie, MU Graz, Graz, Österreich

    R. Roller-Wirnsberger

  4. Institut für Experimentelle und Klinische Pharmakologie, MU Graz, Graz, Österreich

    E. Beubler

  5. Universitätsklinik für Innere Medizin I, MU Innsbruck, Innsbruck, Österreich

    R. Gasser

  6. Akutgeriatrie, LKH Hörgas-Enzenbach, Hörgas-Enzenbach, Österreich

    P. Mrak

  7. Abteilung für Innere Medizin, a.ö. Krankenhaus Barmherzige Brüder Salzburg, Salzburg, Österreich

    F. Hoppichler

  8. Institut für Pathophysiologie und Allergieforschung, MU Wien, Wien, Österreich

    P. Pietschmann

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Lechleitner, M., Pils, K., Roller-Wirnsberger, R. et al. Diabetes und Osteoporose. Z Gerontol Geriat 46, 390–397 (2013). https://doi.org/10.1007/s00391-013-0518-4

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