Gynäkologische Endokrinologie

, Volume 11, Issue 2, pp 129–136 | Cite as

Prävention der postmenopausalen Osteoporose

Teil 1: Erkennung von Risikopatientinnen und nichthormonelle präventive Maßnahmen
Arzneimitteltherapie

Zusammenfassung

Hintergrund

Die Osteoporose ist eine Volkskrankheit und gehört zu den kostenintensivsten Erkrankungen der älteren Frau. Vor allem im höheren Alter und bei allen postmenopausalen Frauen mit Risikofaktoren sowie niedrigen Vitamin-D-Spiegeln sind die adäquate Kalziumaufnahme, erhöhte Vitamin-D-Supplementation und ausreichende Proteinzufuhr essenzielle Bestandteile der Primärprävention.

Vitamin-D-Supplementation

Vitamin D wirkt sich günstig auf den Knochenstoffwechel aus und senkt die Sturzneigung durch eine Verbesserung der Muskelkraft. Manche Quellen empfehlen eine Vitamin-D-Supplementation von 800–1000 IE/Tag. An anderer Stelle wird zu 1500–2000 IE/Tag für Erwachsene > 19 Jahren geraten. Bei älteren Menschen mit hohem Frakturrisiko werden bis zu 2000 IE/Tag empfohlen.

Kalziumzufuhr

Die präventive Wirkung von Vitamin D setzt eine ausreichende, aber nicht exzessive Zufuhr von Kalzium voraus. Heute wird eine Kalziumgesamteinnahme von 1000–1200 mg/Tag empfohlen; sie sollte möglichst alimentär erfolgen. Die Wirksamkeit und Sicherheit einer vernünftigen Kalzium- und Vitamin-D-Gabe ist erwiesen. In Studien, welche die hier definierten Grenzen der Kalziumzufuhr beachteten, nahm das kardiovaskuläre Risiko nicht zu. Eine unkontrollierte zusätzliche Gabe von Kalziumsupplementen ist jedoch nicht indiziert.

Allgemeine Maßnahmen

Zur allgemeinen Prävention gehören regelmäßige körperliche Aktivität, inklusive Krafttraining, und Gleichgewichtsübungen zur Sturzprophylaxe. Vermieden werden sollten Risikofaktoren wie Rauchen, übermäßiger Alkoholkonsum und, sofern möglich, Medikamente, die den Knochenstoffwechsel ungünstig beeinflussen. Allgemeine präventive Maßnahmen sind ungeachtet einer Diagnostik zu empfehlen. Jeder therapeutischen Entscheidung muss hingegen eine geeignete Abklärung von Osteoporose und prävalenten Frakturen vorausgehen.

Schlüsselwörter

Vitamin D Kalzium Körperliche Aktivität Risikofaktoren Frakturrisiko 

Prevention of postmenopausal osteoporosis

Part 1: Identification of patients at risk and nonhormone preventive measures

Abstract

Background

Osteoporosis is one of the most frequent and cost-intensive diseases. In women aged > 50 years and in postmenopausal women of all ages suffering from malnutrition or having an insufficient exposition to sunlight leading to low serum vitamin D levels, an adequate calcium intake, a sufficiently high vitamin D supplementation increasing with age and a sufficient protein intake (minimally 1 g/kg body weight protein per day) are essential for primary prevention of osteoporotic fractures.

Vitamin D supplementation

Vitamin D prevents fractures through two mechanisms. Vitamin D has a positive effect on bone metabolism, and vitamin D increases muscle strength, resulting in a decreased risk of falls. Some sources recommend a vitamin D intake of 800–1000 IU/day. However, others suggest 1500–2000 IU/day vitamin D for adults aged > 19 years. In the elderly having a high fracture risk, up to 2000 IU vitamin D/day is recommended.

Calcium supplements

The preventive effect of vitamin D implies a sufficient, but not excessive daily calcium intake. To prevent osteoporotic fractures, a preferentially alimentary calcium supplementation of 1000–1200 mg/day calcium is recommended. The efficiency and safety of an adequate calcium and vitamin D supplementation has been proven. In particular, in studies observing the calcium intake limits defined above, no increased cardiovascular risk was observed. Uncontrolled additional calcium intake is not indicated.

General measures

General prevention includes regular physical exercise (including strength training) combined with equilibrium training to prevent falls. Risk factors such as cigarette smoking, excessive alcohol intake and—if possible—the intake of drugs having a negative impact on bone metabolism (e.g., glucocorticoids, antiepileptics, suppressive thyroid hormone therapy) should be avoided. General preventive measures can be recommended without specific diagnostic investigations. Each therapeutic decision has to be preceded by an appropriate investigation for osteoporosis and prevalent fractures

Keywords

Vitamin D Calcium Physical exercise Risk factors Fracture risk 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Universität BernBernSchweiz
  2. 2.BaselSchweiz

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