Sekundäre Osteoporose – praxisrelevante Besonderheiten bei der Diagnostik und Therapie

 

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Zusammenfassung

Osteoporose ist eine systemische Skeletterkrankung mit erhöhtem Frakturrisiko. Nach den Ursachen wird zwischen primären (70 – 80 %) und sekundären (20 – 30 %) Osteoporosen unterschieden. Sekundäre Osteoporosen sind alle Formen, die überwiegend und kausal mit bestimmten Erkrankungen und Konditionen verknüpft sind. Ziel der Arbeit ist es, Besonderheiten bei der Diagnosestellung, Prophylaxe und Therapie von sekundären Osteoporosen im Allgemeinen und anhand einiger für die Praxis besonders bedeutsamer Formen darzustellen. Dabei wird auf die Leitlinien des Dachverbandes Osteologie (DVO) von 2009 zur Prophylaxe, Diagnostik und Therapie der Osteoporose und zu ausgewählten Originalarbeiten zu einzelnen Osteoporoseformen Bezug genommen. Richtungsweisend für die Diagnose sind Anamnese, klinische Untersuchung und Basis-Labordiagnostik. Die sekundären Osteoporosen sind oft durch eine rasche Entstehung und schwere Verlaufsformen gekennzeichnet. Entscheidend sind eine frühzeitige Diagnostik, eine Prophylaxe und – wenn möglich – eine rasche kausale Therapie bzw. eine knochenspezifische Therapie, da bereits bei geringerer Erniedrigung der Knochendichte das Frakturrisiko steigt. Die wichtigsten Ursachen einer sekundären Osteoporose sind Medikamente sowie endokrine, gastrointestinale und hämatologische Erkrankungen. Exemplarisch werden die Glukokortikoid-induzierte Osteoporose, die antihormonelle Therapie (Aromatase-Inhibitoren bei Frauen mit Mammakarzinom und antiandrogene Therapie bei Männern mit Prostatakarzinom) sowie ein Vitamin-D-Mangel mit sekundärem Hyperparathyreoidismus dargestellt. Anamnese und Basislabor sind entscheidend, um mögliche Ursachen für eine sekundäre Osteoporose rechtzeitig zu erkennen und eine frühzeitige Diagnostik durchzuführen. Durch eine rasche kausale Therapie oder eine risikoadaptierte medikamentöse Osteoporose-Therapie lässt sich das Risiko für die Entstehung schwerer Osteoporosen mit multiplen Frakturen verringern.

Abstract

Osteoporosis is a systemic skeletal disease causing increased fracture risk. According to pathogenesis, primary (70 – 80 %) and secondary osteoporosis (20 – 30 %) are distinguished. Secondary osteoporosis comprises all entities in which osteoporosis is predominantly and causally associated with certain diseases or conditions. The aim of this review article is to put attention to special features in diagnosis, prophylaxis and treatment of secondary osteoporosis in general and to demonstrate some forms of secondary osteoporosis which seem particularly important during clinical practice. The manuscript refers to the guidelines of the DVO 2009 for prevention, diagnosis and therapy of osteoporosis and selective original papers considering the special types of secondary osteoporosis. History, clinical examination and basic laboratory tests are indicative for the diagnosis of secondary osteoporosis. Its clinical presentation is frequently characterized by rapid development and multiple fractures. Therefore, early diagnosis, prophylaxis and causal treatment is decisive. If causal treatment is impossible, risk adaption of bone mineral density (BMD) for osteoporosis specific treatment is essential. Common causes are medications, endocrine, gastrointestinal and hematologic diseases. Glucocorticoid induced osteoporosis, antihormonal therapy (aromatase inhibitor in women with breast cancer, androgen deprivation therapy in men with prostate cancer) and vitamin D deficiency causing secondary hyperparathyroidism are presented in detail. History and basic laboratory testing are decisive to identify possible causes for secondary osteoporosis and to initiate early diagnostic procedures. The risk of severe osteoporosis can be reduced by early and causal treatment or by risk stratified early bone specific medication if causal therapy is impossible.

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