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Zeitschrift für Gerontologie und Geriatrie

, Volume 52, Issue 5, pp 421–427 | Cite as

Osteoporosediagnostik und -therapie bei über 65-Jährigen

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  • Peter DovjakEmail author
Themenschwerpunkt
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Zusammenfassung

Nur ein Drittel aller Frauen im Alter über 65 Jahren mit einer Osteoporose erhält eine Therapie; viele erleiden eine Fraktur. Bei Männern ist die Datenlage nicht klar. Mithilfe eines neu erarbeiteten Algorithmus und anhand der aktuellen Leitlinien sind die Diagnose und eine spezifische Therapie einfach zu vorzunehmen. Die Differenzialtherapie ist gemäß dem Nebenwirkungsprofil der spezifischen Medikation individuell zu wählen; die therapeutischen Effekte der spezifischen Osteoporosemedikation sind in den Vergleichsstudien nicht signifikant unterschiedlich. Der vorliegende Beitrag bietet eine aktuelle Übersicht über die derzeit verfügbare medikamentöse und nichtmedikamentöse Therapie und fasst Ansätze für eine verbesserte Kontrolle der Erkrankung mithilfe neuer Medikamente und Interventionen zusammen.

Schlüsselwörter

Knochenfrakturen Knochendichte Krankheitsmanagement Leitlinie Algorithmus 

Diagnostics and treatment of osteoporosis in patients over 65 years old

Current status and future perspectives

Abstract

Only one third of all women with osteoporosis over the age of 65 years are adequately treated; therefore, many experience fractures. For men the data are insufficient. Using a newly developed algorithm and based on the current guidelines, the diagnosis and specific treatment of osteoporosis can be easily set up. The differential treatment should be selected in an individualized approach based on the side effect profile of the specific medication. No statistically significant differences were found between most specific osteoporotic drugs in head-to-head comparisons. This article presents an overview of the currently available pharmaceutical and non-pharmaceutical forms of treatment as well as approaches with novel medications and interventions for a better control of osteoporosis.

Keywords

Fractures, bone Bone density Disease management Guidelines Algorithms 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

P. Dovjak gibt 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.

Literatur

  1. 1.
    Hadji P, Klein S, Gothe H et al (2013) The epidemiology of osteoporosis—Bone Evaluation Study (BEST): an analysis of routine health insurance data. Dtsch Arztebl Int 110(4):52–57Google Scholar
  2. 2.
    Siris ES, Yu J, Bognar K et al (2015) Undertreatment of osteoporosis and the role of gastrointestinal events among elderly osteoporotic women with Medicare Part D drug coverage. Clin Interv Aging 10:1813–1824Google Scholar
  3. 3.
    Schray D, Neuerburg C, Stein J et al (2016) Value of a coordinated management of osteoporosis via Fracture Liaison Service for the treatment of orthogeriatric patients. Eur J Trauma Emerg Surg 42(5):559–564CrossRefGoogle Scholar
  4. 4.
    Gamboa A, Duaso E, Marimón P et al (2018) Oral bisphosphonate prescription and non-adherence at 12 months in patients with hip fractures treated in an acute geriatric unit. Osteoporos Int.  https://doi.org/10.1007/s00198-018-4622-6 Google Scholar
  5. 5.
    Nayak S, Greenspan SL (2018) How Can We Improve Osteoporosis Care: A Systematic Review and Meta-Analysis of the Efficacy of Quality Improvement Strategies for Osteoporosis. J Bone Miner Res.  https://doi.org/10.1002/jbmr.3437 Google Scholar
  6. 6.
    Karjalainen JP, Riekkinen O, Töyräs J et al (2012) Multi-site bone ultrasound measurements in elderly women with and without previous hip fractures. Osteoporos Int 23(4):1287–1295CrossRefGoogle Scholar
  7. 7.
    Compston J, Bowring C, Cooper A et al (2013) Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. Maturitas 75(4):392–396CrossRefGoogle Scholar
  8. 8.
    Adler RA (2012) Secondary fracture prevention. Curr Osteoporos Rep 10(1):22–27CrossRefGoogle Scholar
  9. 9.
    Baim S, Leslie WD (2012) Assessment of fracture risk. Curr Osteoporos Rep 10(1):28–41CrossRefGoogle Scholar
  10. 10.
    Gosch M, Stumpf U, Kammerlander C, Böcker W, Heppner HJ, Wicklein S (2018) Management of osteoporosis after fragility fractures. Z Gerontol Geriatr 51(1):113–125CrossRefGoogle Scholar
  11. 11.
    Dovjak P, Föger-Samwald U, Konrad M, Bichler B, Pietschmann P (2014) Secondary confounders of osteoporotic hip fractures in patients admitted to a geriatric acute care department. Z Gerontol Geriatr.  https://doi.org/10.1007/s00391-014-0821-8 Google Scholar
  12. 12.
    Adler RA (2012) Laboratory testing for secondary osteoporosis evaluation. Clin Biochem 45(12):894–900CrossRefGoogle Scholar
  13. 13.
    Bogoch ER, Elliot-Gibson V, Wang RY, Josse RG (2012) Secondary causes of osteoporosis in fracture patients. J Orthop Trauma 26(9):e145–152CrossRefGoogle Scholar
  14. 14.
    Bours SP, van Geel TA, Geusens PP et al (2011) Contributors to secondary osteoporosis and metabolic bone diseases in patients presenting with a clinical fracture. J Clin Endocrinol Metab 96(5):1360–1367CrossRefGoogle Scholar
  15. 15.
  16. 16.
    Langdahl BL, Andersen JD (2018) Treatment of Osteoporosis: Unmet Needs and Emerging Solutions. J Bone Metab 25(3):133–140CrossRefGoogle Scholar
  17. 17.
    Cakir B, Odabasi E, Turan M, Guler S, Kutlu M (2002) Secondary osteoporosis in women. A retrospective analysis. Arch Gynecol Obstet 266(4):214–217CrossRefGoogle Scholar
  18. 18.
    Pietschmann P, Rauner M, Sipos W, Osteoporosis K‑SK (2009) an age-related and gender-specific disease—a mini-review. Gerontology 55(1):3–12CrossRefGoogle Scholar
  19. 19.
    Avenell A, Mak JC, O’Connell D (2014) Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev 4:CD227Google Scholar
  20. 20.
    Black DM, Postmenopausal Osteoporosis RCJ (2016) N Engl J Med 374(21):2096–2097Google Scholar
  21. 21.
    Bolland MJ, Grey A, Reid IR (2015) Should we prescribe calcium or vitamin D supplements to treat or prevent osteoporosis? Climacteric 18(Suppl 2):22–31CrossRefGoogle Scholar
  22. 22.
    Albert SG, Reddy S (2017) CLINICAL EVALUATION OF COST EFFICACY OF DRUGS FOR TREATMENT OF OSTEOPOROSIS: A META-ANALYSIS. Endocr Pract 23(7):841–856CrossRefGoogle Scholar
  23. 23.
    Eriksen EF, Lyles KW, Colón-Emeric CS et al (2009) Antifracture efficacy and reduction of mortality in relation to timing of the first dose of zoledronic acid after hip fracture. J Bone Miner Res 24(7):1308–1313CrossRefGoogle Scholar
  24. 24.
    Aljohani S, Fliefel R, Ihbe J, Kühnisch J, Ehrenfeld M, Otto S (2017) What is the effect of anti-resorptive drugs (ARDs) on the development of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients: A systematic review. J Craniomaxillofac Surg 45(9:1493–1502CrossRefGoogle Scholar
  25. 25.
    Cummings SR, Ferrari S, Eastell R, et al. Vertebral Fractures After Discontinuation of Denosumab: A Post Hoc Analysis of the Randomized Placebo-Controlled FREEDOM Trial and Its Extension. (2018) J Bone Miner Res 33(2):190–198CrossRefGoogle Scholar
  26. 26.
    Rachner TD, Hofbauer L, Göbel A, Tsourdi E (2018) Novel therapies in osteoporosis: PTH-related peptide analogues and inhibitors of sclerostin. J Mol Endocrinol.  https://doi.org/10.1530/JME-18-0173 Google Scholar
  27. 27.
    Ensrud KE, Osteoporosis CCJ (2017) Ann Intern Med 167(3):ITC17–ITC32CrossRefGoogle Scholar
  28. 28.
    Muschitz C, Kocijan R, Fahrleitner-Pammer A, Lung S, Resch H (2013) Antiresorptives overlapping ongoing teriparatide treatment result in additional increases in bone mineral density. J Bone Miner Res 28(1):196–205CrossRefGoogle Scholar
  29. 29.
    Tsai JN, Uihlein AV, Burnett-Bowie SM et al (2016) Effects of Two Years of Teriparatide, Denosumab, or Both on Bone Microarchitecture and Strength (DATA-HRpQCT study). J Clin Endocrinol Metab 101(5):2023–2030CrossRefGoogle Scholar
  30. 30.
    Kanis JA, McCloskey EV, Johansson H et al (2013) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24(1):23–57CrossRefGoogle Scholar
  31. 31.
    Karjalainen JP, Riekkinen O, Kröger H (2018) Pulse-echo ultrasound method for detection of post-menopausal women with osteoporotic BMD. Osteoporos Int.  https://doi.org/10.1007/s00198-018-4408-x Google Scholar
  32. 32.
    Schousboe JT, Riekkinen O, Karjalainen J (2017) Prediction of hip osteoporosis by DXA using a novel pulse-echo ultrasound device. Osteoporos Int 28(1):85–93CrossRefGoogle Scholar
  33. 33.
    Eccles E, Thompson JD, Roddam H (2018) An evaluation of Fracture Liaison Services in the detection and management of osteoporotic fragility fractures: A narrative review. Radiography (Lond) 24(4):392–395CrossRefGoogle Scholar
  34. 34.
    Gosch M, Druml T, Nicholas JA et al (2015) Fragility non-hip fracture patients are at risk. Arch Orthop Trauma Surg 135(1):69–77CrossRefGoogle Scholar
  35. 35.
    Rachner TD, Khosla S, Osteoporosis HLC (2011) now and the future. Lancet 377(9773):1276–1287CrossRefGoogle Scholar
  36. 36.
    Cosman F, Crittenden DB, Adachi JD et al (2016) Romosozumab Treatment in Postmenopausal Women with Osteoporosis. N Engl J Med.  https://doi.org/10.1056/NEJMoa1607948 Google Scholar
  37. 37.
    Lewiecki EM, Dinavahi RV, Lazaretti-Castro M et al (2018) One Year of Romosozumab Followed by Two Years of Denosumab Maintains Fracture Risk Reductions: Results of the FRAME Extension Study. J Bone Miner Res.  https://doi.org/10.0002/jbmr.3622 Google Scholar
  38. 38.
    Langdahl BL, Libanati C, Crittenden DB et al (2017) Romosozumab (sclerostin monoclonal antibody) versus teriparatide in postmenopausal women with osteoporosis transitioning from oral bisphosphonate therapy: a randomised, open-label, phase 3 trial. Lancet 390(10102):1585–1594CrossRefGoogle Scholar
  39. 39.
    Fares A (2018) Pharmacological and Non-pharmacological Means for Prevention of Fractures among Elderly. Int J Prev Med 9:78CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.AkutgeriatrieSalzkammergutklinikum GmundenGmundenÖsterreich

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