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Osteosarkopenie

Osteosarcopenia

  • Schwerpunkt: Osteologie
  • Published:
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Zusammenfassung

Die Osteoporose wird heute als erhöhtes Frakturrisiko verstanden, wobei die Knochendichtemessung mit Dualröntgenabsorptiometrie (DXA) ein nützliches Diagnosekriterium und einen potenten Frakturprädiktor darstellt. Gerade bei geriatrischen Patienten ist das Ergebnis jedoch häufig falsch-negativ, sodass Diagnose, Therapieindikation und Therapieauswahl auf einer klinischen Gesamtevaluation der individuellen Situation beruhen sollten. Die Sarkopenie ist ein geriatrisches Syndrom, das durch einen generalisierten Verlust von Muskelmasse und Muskelfunktion gekennzeichnet ist. Damit verbunden ist eine erhöhte Wahrscheinlichkeit von Stürzen, Frakturen, Behinderung und Mortalität. Seit 2018 kann in Deutschland die Sarkopenie in der Internationalen statistischen Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10. Revision, German Modification (ICD-10-GM: M62.50) codiert werden. Bei entsprechendem Frakturrisiko und Hinweisen auf das Vorliegen einer Sarkopenie sollte im Rahmen der Knochendichtemessung die Gesamtkörperzusammensetzung mittels DXA bestimmt werden. Bei der Behandlung einer Osteosarkopenie müssen neben den pharmakologischen auch nichtpharmakologische Maßnahmen eingesetzt werden. Wichtig ist vor allem, die Ursachen frakturbedingender Stürze zu klären und gegebenenfalls zu beheben sowie regelmäßig die Therapieziele zu überprüfen.

Abstract

Osteoporosis is nowadays understood as an increased risk of fractures, with bone density measurement by dual-energy X‑ray absorptiometry (DXA) being a useful diagnostic criterion and a potent fracture predictor; however, especially in geriatric patients the result is often falsely negative, so that the diagnosis, indications for treatment and treatment selection should be based on an overall clinical evaluation of the individual situation. Sarcopenia is defined as a geriatric syndrome characterized by a generalized loss of skeletal mass and muscle function. Sarcopenia is associated with an increased likelihood of adverse outcomes including falls, fractures, disability and mortality. Since 2018 it is possible in Germany to encode sarcopenia in the International Statistical Classification of Diseases and Related Health Problems, 10th revision, German modification (ICD-10-GM, M62.50). In the case of a high fracture risk and indications for the presence of sarcopenia, the whole body composition should be assessed by DXA within the framework of the measurement of bone mineral density. In the treatment of osteosarcopenia non-pharmacological measures must be initiated in addition to pharmacological measures. It is particularly important to clarify and if necessary to resolve the cause of falls resulting in fractures as well as to regularly reevaluate the treatment goals.

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Authors and Affiliations

  1. Schwerpunkt Akutgeriatrie, Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ziemssenstraße 1, 80336, München, Deutschland

    M. Drey M.Sc. & R. Schmidmaier

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  1. M. Drey M.Sc.
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Correspondence to M. Drey M.Sc..

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M. Drey und R. Schmidmaier geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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H. Lehnert, Salzburg

M. Reincke, München

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Drey, M., Schmidmaier, R. Osteosarkopenie. Internist 62, 505–512 (2021). https://doi.org/10.1007/s00108-021-01025-w

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