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Stellenwert von nativem und biologisch aktivem Vitamin D bei der Prävention und Therapie der Osteoporose

Relative value of plain vitamin D and of biologically active vitamin D in the prevention and treatment of osteoporosis

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Zusammenfassung

Der Vitamin-D-Stoffwechsel spielt eine wichtige Rolle in der Pathogenese der Osteoporose. Bei älteren Menschen in Mitteleuropa ist Vitamin-D-Mangel weit verbreitet. Dieser führt zu einem sekundären Hyperparathyreoidismus und zu einer gesteigerten Knochenresorption. Daraus resultiert eine Osteoporose. Zusammen mit dem bei Vitamin-D-Mangel erhöhten Sturzrisiko resultiert eine erhöhte Knochenbruchgefahr. Bei schwerem Vitamin-D-Mangel kommt es auch zu Mineralisationsstörungen, einer Osteomalazie. Kontrollierte Interventionsstudien mit Vitamin D (und Kalzium) ergaben diskrepante Ergebnisse hinsichtlich der Prävention von extravertebralen Frakturen. Wahrscheinlich ist eine Behandlung mit nativem Vitamin D nur in solchen Populationen effektiv, die eine Mangelsituation für Vitamin D aufweisen.

Die Behandlung mit aktivem Vitamin D (1-alpha-hydroxylierte Metaboliten wie Alfacalcidol) stellt eine pharmakologische Therapie dar, die pleiotrope Effekte auf Darm (Kalziumabsorption), Knochen (Formation), Muskel (Senkung des Sturzrisikos) und Immunsystem hat. Zielgruppen sind insbesondere Patienten mit Störungen des Vitamin-D-Stoffwechsels (Niereninsuffizienz, Glukokortikoid-Therapie, entzündliche Erkrankungen wie rheumatoide Arthritis). Bei Glukokortikoid-Therapie kann Alfacalcidol mit hohem Evidenzgrad den Knochenmassenverlust verhindern. In vergleichenden Studien war Alfacalcidol dem nativem Vitamin D überlegen.

Abstract

Vitamin D metabolism has an important role in the pathogenesis of osteoporosis. Vitamin D deficiency is very common in elderly people in central Europe. This leads to secondary hyperparathyroidism and to increased bone resorption, resulting in osteoporosis. Combined with the elevated risk of falling that results from vitamin D deficiency, this increases the frequency of bone fractures. Severe vitamin D deficiency also causes impaired bone mineralization (osteomalacia). Controlled intervention trials with native vitamin D (and calcium) yielded no consistent results in terms of the prevention of extravertebral fractures. It appears likely that treatment with plain vitamin D is effective only in populations with vitamin D deficiency.

Treatment with active vitamin D (1-alpha-hydroxylated metabolites such as alfacalcidol) has to be considered a pharmacological intervention that exerts pleiotropic effects on the gut (calcium absorption), bone (stimulation of formation), muscle (decreasing of the risk of falling), and immune system. Target groups are patients with disturbed vitamin D metabolism (renal insufficiency, glucocorticoid therapy, inflammatory disease such as rheumatoid arthritis). Alfacalcidol can prevent glucocorticoid-induced bone loss (high-grade evidence). In comparative studies alfacalcidol was superior to plain vitamin D.

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Interessenkonflikt

Der Autor ist als Berater bzw. Vortragsreferent für die Firmen Novartis Consumer Health, Gry pharma, Teva Pharma, Strathmann AG, Merckle und Sanofi-Aventis tätig, die Medikamente mit den im Artikel genannten Substanzen herstellen.

Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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  1. Praxis für Innere Medizin, Salinenstraße 8, 83435, Bad Reichenhall, Deutschland

    S. Scharla

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Scharla, S. Stellenwert von nativem und biologisch aktivem Vitamin D bei der Prävention und Therapie der Osteoporose. Z. Rheumatol. 65, 391–399 (2006). https://doi.org/10.1007/s00393-006-0094-8

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