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Gastrointestinale Erkrankungen und Osteomalazie

Gastrointestinal diseases and osteomalacia

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Zusammenfassung

Die Osteomalazie ist eine metabolische Knochenerkrankung, die mit einer Mineralisierungsstörung des Knochens einhergeht. Ursache ist ein Mangel an Vitamin D und Kalzium, wie er im Rahmen gastrointestinaler Störungen entstehen kann. Gastrointestinale Malabsorptionssyndrome nach Operationen, im Rahmen von Erkrankungen des Dünndarms, des hepatobiliären Trakts und des Pankreas können zu einer verminderten enteralen Resorption des fettlöslichen Vitamin D und/oder einem Verlust der endogenen Vitamin-D-Speicher durch einen gestörten enterohepatischen Kreislauf führen. Dadurch und durch die Erkrankung selbst kommt es zu einer unzureichenden Resorption von Kalzium mit konsekutiver Hypokalzämie und bei fortschreitender Erkrankung zur Entstehung unmineralisierten Knochens. Daneben beeinflussen auch chronische gastrointestinale Entzündungen an sich und die häufig notwendige Therapie mit Steroiden den Knochenstoffwechsel negativ. Die Therapie besteht aus enteraler Substitution von Vitamin D und Kalzium sowie ausreichender Sonnenlichtexposition bzw. künstlicher UVB-Bestrahlung.

Abstract

Osteomalacia is a metabolic bone disease associated with impaired mineralization of the bone due to Vitamin D and Calcium deficiency that can develop in gastrointestinal disorders. Gastrointestinal malabsorption after surgery, in disorders of the small bowl, in diseases of the hepatobiliary tree and in pancreatic insufficiency can lead to decreased enteral resorption of the fat-soluble Vitamin D and/or depletion of endogenous Vitamin D stores due to abnormal enterohepatic circulation. As a consequence of the Vitamin D deficiency in combination with the underlying condition patients develop an impaired calcium absorption resulting in hypocalcaemia, which leads to defective bone mineralization. Additionally chronic gastrointestinal inflammation and corticosteroid therapy – which is often needed in these patients – have a negative effect on bone metabolism as well. The therapy consists of oral substitution of Vitamin D and Calcium as well as sufficient sun light exposure or in severe cases the use of artificial UVB-radiation.

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  1. Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland

    S. Thieler & J. Schölmerich

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  1. S. Thieler
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  2. J. Schölmerich
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Correspondence to S. Thieler.

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Thieler, S., Schölmerich, J. Gastrointestinale Erkrankungen und Osteomalazie. Internist 49, 1197–1205 (2008). https://doi.org/10.1007/s00108-008-2117-9

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