Sturzrisiko bei älteren Menschen

Zusammenfassung

Vitamin-D-Mangel tritt bei älteren Menschen häufig auf. Da Vitamin-D-Metaboliten einen Einfluss auf die Muskelfunktion haben, ist ein Vitamin-D-Mangel mit einem erhöhten Sturzrisiko assoziiert. In älteren Populationen mit Vitamin-D-Mangel kann das Sturzrisiko durch die Behandlung mit nativem Vitamin D verringert werden. Bei Studienteilnehmern mit ausreichendem Vitamin-D-Status wurde jedoch kein konsistenter Therapieeffekt von Vitamin D beobachtet. Die Therapie mit 1α-hydroxylierten Vitamin D-Metaboliten (Calcitriol und Alfacalcidol) senkte in kontrollierten Studien das Sturzrisiko. Bereits eine mäßiggradige Abnahme der Nierenfunktion (Kreatinin-Clearance <65 ml/min) erhöht das Sturzrisiko, wahrscheinlich infolge der reduzierten Aktivität der renalen 1α-Hydroxylase und einer Verringerung der 1,25-Dihydroxyvitamin-D-Konzentration im Serum. Eine Therapie mit 1α-hydroxylierten Vitamin-D-Metaboliten senkt bei Patienten mit eingeschränkter Nierenfunktion das Sturzrisiko.

Summary

Vitamin D deficiency is common in elderly persons. Vitamin D is an important modulator of muscular function. Therefore, vitamin D deficiency is associated with an increased risk of falls. Treatment with plain vitamin D is able to decrease the risk of falls in aging populations with high prevalence of vitamin D deficiency. However, in populations with a sufficient vitamin D status the supplementation with plain vitamin D has no consistent effect on falls. The treatment with active 1-alpha-hydroxylated metabolites (calcitriol, alfacalcidol) lowers the risk of falls, which has been demonstrated in controlled trials. An impairment of renal function (creatinine clearance < 65 ml/min) is associated with an increased risk of falls, which probably results from the decrease of serum 1,25-dihydroxyvitamin D. The treatment with 1-alpha-hydroxylated metabolites, which bypasses metabolism in the kidney, is able to decrease the risk of falls observed in persons with mild renal impairment and creatinine clearance below 65 ml/min.

Schlüsselwörter

Vitamin D - Calcitriol - Alfacalcidol - Muskelfunktion - Stürze - Niereninsuffizienz

Keywords

Vitamin D - calcitriol - alfacalcidol - muscle function - falls - renal impairment

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