Der Orthopäde

, Volume 38, Issue 4, pp 365–380 | Cite as

Aktuelle Diagnostik und Therapie der Osteoporose auf der Basis der „European Guidance 2008“

CME Weiterbildung • Zertifizierte Fortbildung

Zusammenfassung

Die Osteoporose wird heute zu den 10 wichtigsten Volkskrankheiten gezählt und verursacht allein in Deutschland Kosten in Milliardenhöhe. In den letzten 15 Jahren haben Fortschritte in der Diagnostik und in der Entwicklung neuer Medikamente dazu geführt, dass die Osteoporose als ernst zu nehmende, aber vermeidbare bzw. behandelbare Volkskrankheit wahrgenommen wird. Trotz dieser enormen Fortschritte ist die Osteoporose aber immer noch in Europa und insbesondere in Deutschland eine unterdiagnostizierte und untertherapierte Krankheit. So werden in Deutschland nur etwa 10–15% der Patienten mit manifester Osteoporose sowohl im ambulanten wie im stationären Bereich leitliniengerecht behandelt. In Ergänzung zu den nationalen Leitlinien liegt jetzt ein europäisches Positionspapier zu Diagnostik und Management der Osteoporose in Neuauflage vor, das den behandelnden Ärzten weitere Sicherheit und Informationen zur Behandlung von Osteoporosepatienten gibt.

Schlüsselwörter

„European Guidance“ Osteoporose Risikofaktoren Diagnostik Medikamente 

Current diagnosis and therapy of osteoporosis on the basis of “European guidance 2008”

Abstract

Osteoporosis is one of the 10 most important and widespread global diseases. In Germany alone the cost of osteoporosis runs into many billions of Euros. However, it should be noted that in the past 15 years great progress has been made both in diagnosis and in the development of new medications, and this has changed the general perception of and attitude to osteoporosis. It is now taken very seriously and recognised as a national and global disorder which is both preventable and treatable. In spite of this progress, in Europe and especially in Germany, osteoporosis remains an underdiagnosed and undertreated disease. In Germany, only about 10%–15% of patients with manifest osteoporosis are properly treated. However, in addition to national guidelines, there is now a new edition of the “European Position Paper for the Diagnosis and Management of Osteoporosis”. This provides physicians treating osteoporosis patients with additional information and therefore more confidence.

KeyWords

European guidance Osteoporosis Risk factors Diagnosis Drugs 

Literatur

  1. 1.
    Bartl R (2002) Osteoporose: Was ist gesichert in der Therapie? Internist 43:1529–1543PubMedCrossRefGoogle Scholar
  2. 2.
    Bartl R (2007) Leitliniengerechtes Management der Osteoporose: Rationell – kostensparend – effektiv Dtsch Med Wochenschr 132:995–999Google Scholar
  3. 3.
    Bartl R (2008) Osteoporose – Prävention, Diagnostik, Therapie, 3. Aufl. Thieme, StuttgartGoogle Scholar
  4. 4.
    Bartl R, Bartl C, Mutschler W (2003) Diagnostik und Therapie der Osteoporose: Strategie für eine effiziente Prävention von Folgefrakturen. Unfallchirurg 106:526–541PubMedCrossRefGoogle Scholar
  5. 5.
    Bartl R, Frisch B (2004) Osteoporosis: diagnosis, prevention, therapy. A practical guide for all physicians – from pediadrics to geriatrics. Springer, Berlin Heidelberg New YorkGoogle Scholar
  6. 6.
    Bartl R, Frisch B, von Tresckow E, Bartl C (2007) Bisphosphonates in medical practice. Springer, Berlin Heidelberg New YorkGoogle Scholar
  7. 7.
    Bartl R, Goette S, Hadji P, Hammerschmidt T (2005) Persistence and compliance with daily- and weekly-administered bisphosphonates for osteoporosis in Germany. Osteoporos Int 16 (Suppl 3):195Google Scholar
  8. 8.
    Bartl R, Thaler C (2007) Leitliniengerechte Diagnostik und Therapie der postmenopausalen Osteoporose – eine neue Verantwortung für den Gynäkologen. Gynäkologe 40:913–923CrossRefGoogle Scholar
  9. 9.
    Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC et al (1999) Effect of vitamin D on falls: a meta-analysis. JAMA 28:1999–2006Google Scholar
  10. 10.
    Black D et al (2006) Effects of continuing or stopping alendronate after 5 years of treatment. The Fracture Intervention Trial Long-term Extension (FLEX): A randomized trial. JAMA 296:2927–2936PubMedCrossRefGoogle Scholar
  11. 11.
    Black DM, Bilezikian JP, Ensrud KE et al (2005) One year alendronate after one year of parathyroid hormone (1–84) for osteoporosis. N Engl J Med 353:555–565PubMedCrossRefGoogle Scholar
  12. 12.
    Black DM, Delmas PD, Eastell R et al (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356:1809–1822PubMedCrossRefGoogle Scholar
  13. 13.
    Black DM, Greenspan SL, Ensrud KE et al (2003) The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis. N Engl J Med 249:1207–1215CrossRefGoogle Scholar
  14. 14.
    Blake GM, Fogelman I (2007) Role of dual-energy X-ray absorptiometry in the diagnosis and treatment of osteoporosis. J Clin Densitom 10:102–110PubMedCrossRefGoogle Scholar
  15. 15.
    Blake GM, Patel R, Knapp KM, Fogelman I (2003) Does the combination of two BMD measurements improve fracture discrimination. J Bone Miner Res 18:1955–1963PubMedCrossRefGoogle Scholar
  16. 16.
    Bonaiuti D, Shea B, Iovine R et al (2002) Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev 3:CD000333PubMedGoogle Scholar
  17. 17.
    Boonen S, Body JJ, Boutsen Y et al (2005) Evidence-based guidelines for the treatment of postmenopausal osteoporosis: a consensus document of the Belgian Bone Club. Osteoporos Int 16:239–254PubMedCrossRefGoogle Scholar
  18. 18.
    Bruyère O, Roux C, Detilleux J et al (2007) Relation between bone mineral density changes and fracture risk reduction in patients treated with strontium ranelate. J Clin Endocrinol Metab 92:3076–3081PubMedCrossRefGoogle Scholar
  19. 19.
    Burge R, Dawson-Hughes B, Solomon D et al (2007) Incidence and economic burden of osteoporostic-related fractures in the United States. 2005–2025. J Bone Miner Res 22:465–475PubMedCrossRefGoogle Scholar
  20. 20.
    Caro JJ, Ishak KJ, Huybrechts KF et al (2004) The impact of compliance with osteoporosis therapy on fracture rates in actual practice. Osteoporos Int 15:1003–1008PubMedCrossRefGoogle Scholar
  21. 21.
    Carr AJ, Thompson PW, Cooper C (2006) Factors associated with adherence and persistence to bisphosphonate therapy in osteoporosis: a cross-sectional survey. Osteoporos Int 17:1638–1644PubMedCrossRefGoogle Scholar
  22. 22.
    Chen P, Miller PD, Delmas PD et al (2006) Change in lumbar spine BMD and vertebral fracture risk reduction in teriparatide treated postmenopausal women with osteoporosis. J Bone Miner Res 21:1785–1790PubMedCrossRefGoogle Scholar
  23. 23.
    Consensus Development Conference (1993) Diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 94:646–650CrossRefGoogle Scholar
  24. 24.
    Cooper C, Atkinson EJ, Jacobsen SJ et al (1993) A population based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005PubMedGoogle Scholar
  25. 25.
    Cranney A, Guyatt G, Griffith L et al (2002) Meta-analyses of therapies for postmenopausal osteoporosis. IX. Summary of meta-analyses of therapies for postmenopausal osteoporosis. Endocr Rev 23:570–578PubMedCrossRefGoogle Scholar
  26. 26.
    Cranney A, Tugwell P, Zyatruk N et al (2002) Meta-analysis of calcitonin for the treatment of postmenopausal osteoporosis. Endocr Rev 23:540–551PubMedCrossRefGoogle Scholar
  27. 27.
    Cummings SR, Eckert S, Krueger KA et al (1999) The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple outcomes of raloxifene evaluation. JAMA 281:2189–2197PubMedCrossRefGoogle Scholar
  28. 28.
    Cummings SR, Karpf DB, Harris F et al (2006) Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs. Am J Med 112:281–289CrossRefGoogle Scholar
  29. 29.
    DaFonseca K, Baier M, Grafe I et al (2006) Ballonkyphoplastie in der Therapie der Wirbelkörperfrakturen. Orthopäde 35:1101–1110PubMedCrossRefGoogle Scholar
  30. 30.
    Delmas P, Adami S, Strugala C et al (2006) Intravenous ibandronate injections in postmenopausal women with osteoporosis: one-year results from the dosing intravenous administration study. Arthritis Rheum 54:1838–1846PubMedCrossRefGoogle Scholar
  31. 31.
    Delmas P, Rizzoli R, Cooper C (2005) Treatment of patients with postmenopausal osteoporosis is worthwile. The position of the International Osteoporosis Foundation. Osteoporos Int 16:1–5PubMedCrossRefGoogle Scholar
  32. 32.
    Engelke K, Gluer CC (2006) Quality and performance measures in bone densitometry. I. Errors and diagnosis. Osteoporos Int 17:1283–1292PubMedCrossRefGoogle Scholar
  33. 33.
    Grady D (2003) Postmenopausal hormones – therapy for symptoms only. N Engl J Med 348:1835–1837PubMedCrossRefGoogle Scholar
  34. 34.
    Harada S, Rodan G (2003) Control of osteoblast function and regulation of bone mass. Nature 423:349–355PubMedCrossRefGoogle Scholar
  35. 35.
    Harris ST, Watts NB, Genant HK et al (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. JAMA 282:1344–1352PubMedCrossRefGoogle Scholar
  36. 36.
    Häussler B, Gothe H, Mangiapane S et al (2006) Versorgung von Osteoporose-Patienten in Deutschland. Ergebnisse der BoneEVA-Studie. Dtsch Ärztebl 39:B2199–B2205Google Scholar
  37. 37.
    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733PubMedCrossRefGoogle Scholar
  38. 38.
    Johnell O, Oden A, De Laet C et al (2002) Biochemical markers and the assessment of fracture probability. Osteoporos Int 13:523–526PubMedCrossRefGoogle Scholar
  39. 39.
    Kanis J, Burlet N, Cooper C et al (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal osteoporosis. Osteoporos Int 19:399–428PubMedCrossRefGoogle Scholar
  40. 40.
    Kanis JA, Adams J, Borgström F et al (2008) The cost-effectiveness of alendronate in the management of osteoporosis. Bone 42:4–15PubMedCrossRefGoogle Scholar
  41. 41.
    Kanis JA, Glüer CC (2000) for the Committee of Scientific Advisors, International Osteoporosis Foundation An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporos Int 11:192–202PubMedCrossRefGoogle Scholar
  42. 42.
    Kanis JA, Johnell O (2005) on behalf of the Committee of Scientific Advisors of the International Osteoporosis Foundation Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int 16:220–238Google Scholar
  43. 43.
    Kanis J, Johnell O, Oden A et al (2005) Intervention threshholds for osteoporosis in men and women: a study based on data from Sweden. Osteoporos Int 16:6–14PubMedCrossRefGoogle Scholar
  44. 44.
    Kanis JA, Oden A, Johnell O et al (2003) The components of excess mortality after hip fracture. Bone 32:468–473PubMedCrossRefGoogle Scholar
  45. 45.
    Lewiecki EM, Watts NB, McClung MR et al (2004) Official position of the International Society for Clinical Densitometry. J Clin Endocrinol Metab 89:3651–3655PubMedCrossRefGoogle Scholar
  46. 46.
    Looker AC, Wahner HW, Dunn WL et al (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–486PubMedCrossRefGoogle Scholar
  47. 47.
    Lyles KW, Colon-Emeric CS, Magaziner JS et al (2007) the HORIZON recurrent fracture trial zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 357:1799–1809PubMedCrossRefGoogle Scholar
  48. 48.
    McClung MR, Geusens P, Miller PD et al (2001) Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 344:333–340PubMedCrossRefGoogle Scholar
  49. 49.
    Miller P, Zapalowski C, Kulak C et al (1999) Bone densitometry: the best way to detect osteoporosis and to monitor therapy. J Clin Endocrinol Metab 84:1867–1871PubMedCrossRefGoogle Scholar
  50. 50.
    Murray CJL, Lopez AP (1996) Global and regional descriptive epidemiology of disability. Incidence, prevalence, health expectancies and years lived with disability. In: Murray CJL, Lopez AD (eds) The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge/MAGoogle Scholar
  51. 51.
    Myers AH, Young Y, Langlois JA (1996) Prevention of falls in the elderly. Bone 18:87S–101SPubMedCrossRefGoogle Scholar
  52. 52.
    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 344:1434–1441PubMedCrossRefGoogle Scholar
  53. 53.
    Oliver D, Connelly JB, Victor CR et al (2007) Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. BMJ 334:82PubMedCrossRefGoogle Scholar
  54. 54.
    Pazianas M, Blumentals W, Miller P (2008) Lack of association between oral bisphosphonates and osteonecrosis using jaw surgery as a surrogate marker. Osteoporos Int 19:773–778PubMedCrossRefGoogle Scholar
  55. 55.
    Rabenda V, Hanssens L, De Ceulaer F, Reginster JY (2005) Is there any interest in combining treatments in osteoporosis? Curr Rheumatol Rev 1:49–55CrossRefGoogle Scholar
  56. 56.
    Rabenda V, Mertens R, Fabri V et al (2008) Adherence to bisphosphonates therapy and hip fracture risk in osteoporotic women. Osteoporos Int 19:811–818PubMedCrossRefGoogle Scholar
  57. 57.
    Raisz LG (2005) Screening of osteoporosis. N Engl J Med 353:164–171PubMedCrossRefGoogle Scholar
  58. 58.
    Reginster JY, Rabenda V (2006) Adherence to anti-osteoporotic treatment: does it really matter? Future Rheumatol 1:37–40CrossRefGoogle Scholar
  59. 59.
    Reginster JY, Seeman E, De Vernejoul MC et al (2005) Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study. J Clin Endocrinol Metab 90:2816–2822PubMedCrossRefGoogle Scholar
  60. 60.
    Richy F, Ethgen O, Bruyere O, Reginster JY (2004) Efficacy of alfacalcidol and calcitriol in primary and corticosteroid-induced osteoporosis: a meta-analysis of their effects on bone mineral density and fracture rate. Osteoporos Int 15:301–310PubMedCrossRefGoogle Scholar
  61. 61.
    Richy F, Schacht E, Bruyere O et al (2005) Vitamin D analogs versus native vitamin D in preventing bone loss and osteoporosis-related fractures: a comparative meta-analysis. Calcif Tissue Int 76:176–186PubMedCrossRefGoogle Scholar
  62. 62.
    Rizzoli R, Bonjour JP (2004) Dietary protein and bone health. J Bone Miner Res 19:527–531PubMedCrossRefGoogle Scholar
  63. 63.
    Rosen C (2005) Postmenopausal osteoporosis. N Engl J Med 353:595–603PubMedCrossRefGoogle Scholar
  64. 64.
    Russell R, Watts N, Ebentino F, Rogers M (2008) Mechanisms of action of bisphosphonates: similarities and differences and their potential influence on clinical efficacy. Osteoporos Int 19:733–759PubMedCrossRefGoogle Scholar
  65. 65.
    Sambrook P, Cooper C (2006) Osteoporosis. Lancet 367:2010–2018PubMedCrossRefGoogle Scholar
  66. 66.
    Siris E, Chen Y, Abbott T et al (2004) Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 164:1108–1112PubMedCrossRefGoogle Scholar
  67. 67.
    Solomon DH, Avorn J, Katz JN et al (2006) Compliance with osteoporosis medications. Arch Intern Med 165:2414–2419CrossRefGoogle Scholar
  68. 68.
    Stevenson M, Lloyd Jones M, De Nigris E et al (2005) A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis. Health Technol Assess 9:1–160PubMedGoogle Scholar
  69. 69.
    Van Staa TP, Geusens P, Zhang B et al (2007) Individual fracture risk and the cost-effectiveness of bisphosphonates in patients using oral glucocorticoids. Rheumatology (Oxford) 46:460–466Google Scholar
  70. 70.
    Watts NB (2004) Fundamentals and pitfalls of bone densitometry using dual-energy X-ray absorptiometry (DXA). Osteoporos Int 15:847–854PubMedCrossRefGoogle Scholar
  71. 71.
    Watts NB, Geusens P, Barton IP, Felsenberg D (2005) Relationship between changes in BMD and non-vertebral fracture incidence associated with risedronate: reduction in risk of nonvertebral fracture is not related to change in BMD. J Bone Miner Res 20:2097–2104PubMedCrossRefGoogle Scholar
  72. 72.
    Women‘s Health Initiative Group (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA 288:321–333CrossRefGoogle Scholar
  73. 73.
    World Health Organization (2007) Assessment of osteoporosis at the primary health care level. Summary Report of a WHO Scientific Group. WHO, GenevaGoogle Scholar
  74. 74.
    Zethraeus N, Ström O, Borgström F et al (2007) The cost-effectiveness of the treatment of osteoporosis, hypertension and hyperlipidaemia in Sweden. Osteoporos Int 18:9–23PubMedCrossRefGoogle Scholar
  75. 75.
    Zethraeus N, Ström O, Borgström F et al (2008) The cost-effectiveness of the treatment of high risk women with osteoporosis, hypertension and hyperlipidaemia in Sweden. Osteoporos Int 19:819–827PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Bayerisches Osteoporosezentrum Universität München-GroßhadernMünchenDeutschland
  2. 2.Klinik und Poliklinik für Orthopädie und UnfallchirurgieTechnische Universität MünchenMünchenDeutschland

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