Osteoporose und Frakturrisiko bei Diabetes mellitus

Zusammenfassung

Diabetes mellitus und Osteoporose sind Erkrankungen, die bei älteren Patienten gehäuft auftreten. Osteoporotische Frakturen sind mit einer erheblichen Morbidität und Mortalität assoziiert. Neuere Untersuchungen zeigen, dass Patienten mit Diabetes mellitus ein erhöhtes Risiko für Frakturen der Hüfte, des Humerus und des Fußskeletts aufweisen. Ursächlich für dieses gesteigerte Frakturrisiko ist eine verminderte Knochenqualität, wobei die genauen Pathomechanismen der Störung noch nicht abschließend geklärt sind. Für Patienten mit Typ-1-Diabetes wurde in einigen Studien eine verringerte Knochendichte beschrieben, während Patienten mit Typ-2-Diabetes in den meisten Untersuchungen erhöhte Knochendichtewerte aufweisen. Das Frakturrisiko bei älteren Patienten mit Typ-2-Diabetes ist teilweise durch eine höhere Sturzneigung zu erklären. Diabetes- assoziierte Komorbiditäten wie Polyneuropathie oder Retinopathie können das Sturzrisiko direkt beeinflussen. Eine optimale Stoffwechselkontrolle sowie die Integration strukturierter Trainingsprogramme zur Konditionierung der muskuloskelettalen Funktion sollten Bestandteil des Gesamtbehandlungskonzeptes dieser Patienten sein.

Summary

Diabetes mellitus and osteoporosis affect a large proportion of older adults. Osteoporotic fractures have a major impact on morbidity and mortality. Recent cohort studies indicate that diabetes itself is associated with increased risk of fractures of the hip, proximal humerus and foot. Impaired bone quality may contribute to the increased fracture risk in diabetic patients. However, the mechanism resulting in reduced bone strength remains unclear. Observational studies suggest lower bone mineral density in patients with type 1 diabetes, whereas patients with type 2 diabetes have higher bone mineral density. Fracture risk in older patients is enhanced by more frequent falls. Diabetic microvascular complications such as polyneuropathy and retinopathy have direct impact on risk of falls. Appropriate metabolic control in combination with muscle strength and balance training should be concidered in an integrate concept of treatment.

Schlüsselwörter

Diabetes mellitus - Osteoporose - Knochendichte - Fraktur - Osteoblast - Osteoklast

Keywords

Diabetes mellitus - osteoporosis - bone density - fracture - osteoblast - osteoclast

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