Zusammenfassung
Die Osteoporose stellt eine häufige Systemerkrankung des Skeletts dar, die mit dem Alter zunimmt. Dabei kommt es ab dem 50. Lebensjahr zu einer kontinuierlichen Abnahme der Knochendichte bis zum möglichen Auftreten von Frakturen. Das Auftreten einer Osteoporose korreliert positiv mit dem Altershypogonadismus. Verstärkt wird sie unter einer antiandrogenen Therapie beim Prostatakarzinom.
Die Abklärung einer Osteoporose sollte in Zusammenarbeit mit einem Endokrinologen erfolgen. Vor Einleitung einer antiandrogenen Therapie bei Patienten mit Prostatakarzinom empfiehlt sich die Durchführung einer Knochendichtemessung. Generell besteht eine Behandlungsindikation bei aufgetretenen Frakturen und/oder einer Abnahme der Knochendichte von <2,5 der Standardabweichung im Vergleich zur jungen gesunden Bevölkerung. In der Therapie wird eine Kalzium- und Vitamin-D-Substitution mit einer oralen oder intravenösen Bisphosphonat-Gabe kombiniert.
Abstract
Osteoporosis is a systemic disease of the bones with increasing incidence in the elderly. Over the age of 50 years bone mineral density continuously decreases resulting in osteoporotic fracture. Osteoporosis is positively correlated with late-onset hypogonadism and increases under androgen deprivation therapy.
The evaluation of osteoporosis should be done in cooperation with an endocrinologist. Measurement of bone mineral density is recommended before starting androgen deprivation therapy. Patients with fracture and/or decreased bone mineral density 2.5 or more standard deviations below normal peak bone mass of young men should be treated. The appropriate treatment is calcium and vitamin D substitution combined with oral or i.v. administration of bisphosphonates.
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Literatur
Ahonen MH, Tenkanen L, Teppo L et al. (2000) Prostate cancer risk and prediagnostic serum 25-hydroxyvitamin D levels (Finland). Cancer Causes Control 11: 847–852
Allain TJ (2006) Prostate cancer, osteoporosis and fracture risk. Gerontology 52: 107–110
Australian National Consensus Conference (1997) The prevention and management of osteoporosis – consensus statement. Med J Aust 167(Suppl 1): 4–14
Bilezikian JP (1999) Osteoporosis in men. J Clin Endocrinol Metab 84: 3431–3434
Black DM, Thompson DE, Bauer DC et al. (2000) Fracture Intervention Trial. Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. FIT Research Group. J Clin Endocrinol Metab 85: 4118–4124
Diemer T, Hauck EW, Rohde V, Weidner W (2005) Therapie des „Aging male“. Urologe 44: 1173–1178
Ettinger B, Black DM, Mitlak BH et al. (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 18; 282: 637–645
Holmes-Walker DJ, Woo H, Gurney H et al. (2006) Maintaining bone health in patients with prostate cancer. Med J Am 184: 176–179
Jacob F (2005) Primäre und sekundäre Osteoporose. Internist 46(Suppl 1): 24–30
Kann PH (2005) Sekundäre Osteoporose bei endokrinen Erkrankungen. Dtsch Med Wochenschr 130: 165–170
Kiebzak GM, Beinart GA, Perser K et al. (2002) Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med 28; 162: 2217–2222
Kurland ES, Cosman F, McMahon DJ et al. (2000) Parathyroid hormone as a therapy for idiopathic osteoporosis in men: effects on bone mineral density and bone markers. J Clin Endocrinol Metab 85: 3069–3076
Matsumoto AM, Tenover L, McClung M et al. (2002) The long-term effect of specific type II 5alpha-reductase inhibition with finasteride on bone mineral density in men: results of a 4-year placebo controlled trial. J Urol 167: 2105–2108
Neer RM, Arnaud CD, Zanchetta JR et al. (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 10(344): 1434–1441
Ockrim JL, Lalani EN, Laniado ME et al. (2003) Transdermal estradiol therapy for advanced prostate cancer – forward to the past? J Urol 169: 1735–1737
Orwoll E, Ettinger M, Weiss S et al. (2000) Alendronate for the treatment of osteoporosis in men. N Engl J Med 31(343): 604–610
Maerevoet M, Martin C, Duck L (2005) Osteonecrosis of the jaw and bisphosphonate. N Eng J Med 353: 99–102
Papadimitropoulos E, Wells G, Shea B et al. (2002) Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group. Meta-analyses of therapies for postmenopausal osteoporosis. VIII: Meta-analysis of the efficacy of vitamin D treatment in preventing osteoporosis in postmenopausal women. Endocr Rev 23: 560–569
Reid IR, Brown JP, Burckhardt P et al. (2002) Intravenous zoledronic acid in postmenopausal women with low bone mineral density. N Engl J Med 28(346): 653–661
Ross RW, Small EJ (2002) Osteoporosis in men treated with androgen deprivation therapy for prostate cancer. J Urol 167: 1952–1956
Scherr D, Pitts WR Jr, Vaughn ED Jr (2002) Diethylstilbesterol revisited: androgen deprivation, osteoporosis and prostate cancer. J Urol 167: 535–538
Seeman E (2002) Pathogenesis of bone fragility in women and men. Lancet 25(359): 1841–1850
Segal RJ, Reid RD, Courneya KS et al. (2003) Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol 21: 1653–1659
Shahinian VB, Kuo YF, Freeman JL, Goodwin JS (2005) Risk of fracture after androgen deprivation for prostate cancer. N Engl J Med 13(352): 154–164
Sieber PR, Keiller DL, Kahnoski RJ et al. (2004) Bicalutamide 150 mg maintains bone mineral density during monotherapy for localized or locally advanced prostate cancer. J Urol 171: 2272–2276
Smith MR (2006) Treatment-related osteoporosis in men with prostate cancer. Clin Cancer Res 15(12): 6315–6319
Smith MR, McGovern FJ, Zietman AL et al. (2001) Pamidronate to prevent bone loss during androgen-deprivation therapy for prostate cancer. N Engl J Med 27(345): 948–55
Smith MR, Eastham J, Gleason DM et al. (2003) Randomized controlled trial of zoledronic acid to prevent bone loss in men receiving androgen deprivation therapy for nonmetastatic prostate cancer. J Urol 169: 2008–2012
Wallach S, Cohen S, Reid DM et al. (2000) Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy. Calcif Tissue Int 67: 277–285
Writing Group for the Women‘s Health Initiative Investigation (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women‘s Health Initiative and randomised controlled trial. JAMA 288: 321–333
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Lümmen, G., Rübben, H., Schneider, T. et al. Prävention der Osteoporose – wichtig für den Urologen?. Urologe 46, 651–655 (2007). https://doi.org/10.1007/s00120-007-1349-y
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DOI: https://doi.org/10.1007/s00120-007-1349-y