Unsichere Datenlage - Therapie sekundärer und seltener Osteoporose-Formen

Zusammenfassung

Die Osteoporose des Mannes, Osteoporosen in jüngerem Lebensalter und sekundäre Osteoporosen sind (mit Ausnahme der glukokortikoidinduzierten Osteoporose) noch nicht in den evidenzbasierten Leitlinien des Dachverbandes Osteologie (DVO) erfasst. Für die Osteoporose des Mannes gibt es Daten, die eine Empfehlung zur Therapie mit Alendronat erlauben. Unsicherheiten bestehen hier bezüglich der Diagnostik und der Einschätzung der Frakturgefährdung aufgrund der Knochenmineraldichte. Für viele andere Osteoporosen ist die Datenlage sehr dünn, sodass derzeit die Erstellung evidenzbasierter Leitlinien schwer fiele. Bei den sekundären Osteoporosen kann die kausale Therapie durch einen Fachspezialisten bezüglich des Knochens eine Restitutio ad Integrum erreichen. Doch die Erkrankung bleibt ein lebenslanger Risikofaktor für die Entstehung einer manifesten Osteoporose. Entwickelt sich trotz effektiver Behandlung der Grunderkrankung eine manifeste Osteoporose, so kann man unter Beachtung der Besonderheiten des jeweiligen Lebensalters in Anlehnung an die Algorithmen der jetzt verfügbaren Leitlinien handeln.

Summary

The new evidence-based DVO guidelines for osteoporosis diagnosis and therapy do not yet comprise male osteoporosis, osteoporoses of the young and secondary osteoporoses (apart from that induced by glucocorticoids). There are data in the literature for male osteoporosis, which allow for therapeutic recommendations using alendronate, but substantial data are missing for diagnosis and the estimation of fracture risk. Establishing evidence-based guidelines for all other forms of osteoporosis would be difficult to date, because the data base in the literature is scarce. In secondary osteoporosis treatment of the underlying disease by a specialist may lead to complete restitution of bone. These patients however carry a substantial actual and live long risk to develop osteoporosis. Thus if osteoporosis develops in spite of effective treatment of underlying diseases, it should be treated in accordance with the new guidelines when ever possible.

Key Words

male osteoporosis - secondary osteoporoses

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Anschrift des Verfassers