Prophylaxe und Therapie der Glukokortikoid-induzierten Osteoporose

2017 ◽  
Vol 42 (03) ◽  
pp. 233-244
Author(s):  
Peter Oelzner ◽  
Gunter Wolf
Keyword(s):  
Vitamin D ◽  
Medikamentöse Therapie ◽  
T Score

ZusammenfassungDie Glukokortikoid-induzierte Osteoporose (GK-OP) ist eine der häufigsten Formen der Osteoporose. Epidemiologischen Untersuchungen zufolge nehmen 0,5–0,9% der Bevölkerung Glukokortikoide (GK) ein, bei den über 50-jährigen liegt diese Zahl bei ca. 3%. Das Frakturrisiko ist unter chronischer GK-Therapie auf das Doppelte erhöht und liegt auf Grund der bevorzugten Wirkung von GK auf den trabekulären Knochen für Wirbelkörperfrakturen noch höher. Pathogenetisch liegt der GK-OP eine Verminderung von Knochenmasse und – qualität zugrunde, welche aus suppressiven Effekten von GK auf die Zahl und Funktion von Osteoblasten und Osteocyten und einer Steigerung der Knochenresorption resultiert. Systemische Effekte welche zu Sarkopenie mit erhöhtem Sturzrisiko, hormonellen Veränderungen und negativer Kalziumbilanz führen, können die ungünstigen Wirkungen von GK auf den Knochen weiter amplifizieren. Eine Osteoporose-Basisdiagnostik inklusive Osteodensitometrie sollte immer dann erfolgen, wenn mit einer GK-Therapie von mindestens 2,5 mg/d Prednisolonäquivalent über mehr als 3 Monate zu rechnen ist. Das Frakturrisiko ist bereits nach 3 Monaten GK-Therapie erhöht. Daher ist eine frühzeitige Intervention zur Hemmung des GK-induzierten Knochenmasseverlustes angezeigt. Die Leitlinien des Dachverbandes osteologischer Gesellschaften (DVO) liefern die Grundlage für eine am kalkulierten Frakturrisiko orientierte Prophylaxe und Therapie der GK-OP. Zu den allgemeinen Maßnahmen zählen Sturzprävention und Verbesserung von Muskelmasse und Koordination ebenso wie eine ausreichende Versorgung mit Kalzium und Vitamin D. Die Indikationsstellung für eine über diese Maßnahmen hinausgehende spezifische medikamentöse Therapie basiert auf dem individuellen Frakturrisiko, welches entscheidend durch GK-Dosis und Dauer der Therapie, Alter, Geschlecht und weitere Risikofaktoren einschließlich der mit GK behandelten Grunderkrankung bestimmt wird. Für die Umsetzung der Empfehlungen ist insbesondere im prophylaktischen Ansatz eine Kalkulation der geplanten GK-Dauer und Dosis essentiell. In diesem Zusammenhang bieten die Leitlinien zur Therapie der verschiedenen entzündlich rheumatischen Erkrankungen eine wichtige Orientierungshilfe. Bei GK-Dosen von≥7,5 PubMed mg/d Prednisolonäquivalent über mehr als 3 Monate ist eine spezifische medikamentöse Therapie bei einem T-Score von<− 1,5 bzw. beim Vorliegen einer niedrig-traumatischen Wirbelkörperfraktur oder multipler peripherer Frakturen indiziert. GK-Dosen zwischen 2,5 und 7,5 mg/d bedingen eine Absenkung der durch Alter, Geschlecht und weitere Risikofaktoren bestimmten Therapieschwelle. Eine Prävention des GK-induzierten Knochenmasseverlustes und von vertebralen Frakturen wurde sowohl für Bisphosphonate als auch für Teriparatid nachgewiesen.Bisphosphonate eignen sich insbesondere zur Prävention, Teriparatid zur Behandlung der schweren Osteoporose mit prävalenten Frakturen. Entscheidend ist eine noch konsequentere Umsetzung der Empfehlungen zur Prophylaxe und Therapie der GK-OP.

scholarly journals Multimarker method in the study of laboratory predictors of vascular wall elasticity as the basis for the development of a personalized approach to the treatment of socially significant diseases

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
T Petelina ◽  
K Avdeeva ◽  
N Musikhina ◽  
L Gapon ◽  
S Bykova ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Postmenopausal Women ◽  
Ldl Cholesterol ◽  
Blood Pressure Monitoring ◽  
Vascular Inflammation ◽  
Fold Increase ◽  
Endothelin 1 ◽  
T Score ◽  
Markers Of Inflammation

Abstract Funding Acknowledgements Type of funding sources: None. Aim To investigate the role of markers of vascular inflammation, vitamin D, parathyroid hormone as predictors of increased pulse-wave velocity (PWV) and degenerative bone changes in postmenopausal women with arterial hypertension (AH). Methods 164 females were examined. Gr.1 included 42 healthy individuals, Gr.2 - 58 patients with AH and Gr.3 - 64 postmenopausal women with AH and osteoporosis. Parameters of blood pressure monitoring; PWV, osteodensitometry (T-Score); inflammatory markers: hsCRP, TNFα, homocysteine, IL-1β, 6, 8, endothelin-1; lipid profile parameters; sex and parathyroid hormones, vitamin D  were measured. Results In Gr.3 excess levels of PWV, hsCRP, homocysteine, IL8, total cholesterol, LDL cholesterol, endothelin-1 and parathyroid hormone was detected with decrease in the level of sex hormones and vitamin D. Besides, negative correlations of T-Score with age, PWV, duration of menopause, IL-6, hsCRP were registered; positive correlations between PWV with IL6, LDL cholesterol, hsCRP, endothelin-1, DBP variability were found. The logistic regression method revealed the main markers that affect increase of PWV, such as hsCRP and endothelin-1.Rise of each marker by unit of measurement leads to increase in PWV by 1.3 times and 2.4%, respectively. In Gr.2 increase in PWV level of more than 12.05 m/s was associated with 3.8-fold increase in the risk of osteoporosis. In Gr.3 increase in PWV level on 1 m/s was associated with 6 fold increase in the risk of osteoporosis. Conclusions Elevated levels of PWV are associated with markers of inflammation, levels of parathyroid hormone, vitamin D, T-Score and may be part of the pathogenesis of the cardiovascular continuum in postmenopausal women, which will require an individual approach to the treatment of AH with comorbid metabolic disorders.

scholarly journals Study of prevalence of osteoporosis in males of above 40 years age group attending SMS Hospital, Jaipur

2017 ◽  
Vol 3 (4) ◽  
pp. 837
Author(s):  
Parwez Qureshi ◽  
R. C. Meena ◽  
Jakir Husain ◽  
Gaurav Deshwar ◽  
Vineet Maheshwari ◽  
...  
Keyword(s):  
Vitamin D ◽  
Dietary Habits ◽  
Good Control ◽  
Age Group ◽  
Mineral Density ◽  
Cross Sectional ◽  
T Score ◽  
Vitamin D Levels ◽  
Study Population ◽  
Prevalence Of Osteoporosis

<p class="abstract"><strong>Background:</strong> Whenever osteoporosis is discussed, the focus is on women; men are far less likely to receive a diagnosis of osteoporosis or osteoporotic fracture because of considerable gaps in knowledge on male osteoporosis. The aim and objectives were to study the prevalence of osteoporosis in males of above 40 year age group attending SMS Hospital Jaipur &amp; to explore the influence of various modifiable and non-modifiable risk factors on BMD.</p><p class="abstract"><strong>Methods:</strong> Study Location: SMS Medical College and Hospital, Jaipur. Study design: Hospital based cross sectional study. Study period: April 2015 to December 2016. Sample Size: 200. Work up: After taking ethical clearance and informed verbal consent, demographic and clinical details were noted along with S- calcium, Vitamin D and bone mineral density assessment. Osteoporosis was defined as T score ≤−2.5 bone mass −1 to −2.5 and normal as &gt;−1. Data thus collected was analysed with help of SPSS 22.0 through frequency, percentages, Mean, SD and ANOVA.<strong></strong></p><p class="abstract"><strong>Results:</strong> Prevalence of osteopenia and osteoporosis in the study population was 28.5% and 11.5%. Age wise maximum prevalence was in the age group 71-80 years (31.81%). Prevalence of osteoporosis was more among Muslim community 20.83%, more in low socio economic group (BPL). T score of study population was -0.3705±1.41. The mean BMI, S-Calcium, Vitamin D levels and T score values among osteopenic and osteoporotic patients were statistically highly significant when compared to patients without osteo-penic/porotic changes (p&lt;0.05).</p><p><strong>Conclusions:</strong> Osteoporosis is a silent killer and prevention is better than cure as prevention requires simple steps such as good dietary habits, active life style, good control of systemic disorders, reduced intake of tobacco and alcohol.</p>

scholarly journals Longterm Antiepileptic Therapy and Bone Health: Implications for Patients with Brain Tumors

2021 ◽  
Vol 49 (1, 2, 3) ◽  
pp. 23
Author(s):  
Admir Mehičević ◽  
Nevena Mahmutbegović ◽  
Ibrahim Omerhodžić ◽  
Enra Mehmedika Suljić
Keyword(s):  
Vitamin D ◽  
Brain Tumors ◽  
Bone Health ◽  
Monotherapy Group ◽  
Z Score ◽  
Mineral Density ◽  
Cross Sectional ◽  
Antiepileptic Agents ◽  
T Score ◽  
Significant Difference

<p><strong>Objective. </strong>The objective of our study was to investigate the effects of carbamazepine (CBZ) and lamotrigine (LTG) treatment on bone metabolism in epileptic patients.</p><p><strong>Patients and Methods. </strong>A cross-sectional study was performed on normal controls (N=30) and 100 patients with symptomatic epilepsy caused by a primary brain tumor, divided into two groups according to the treatment: LTG monotherapy group (N=50) and CBZ monotherapy group (N=50). For each participant serum levels of 25-OHD and osteocalcin (OCLN) were measured, and bone mineral density (BMD) was evaluated by the dual-energy X-ray absorptiometry method.</p><p><strong>Results</strong>. There was no statistically significant difference in the average values of vitamin D in serum between the CBZ and LTG groups (Vitamin D CBZ 17.03±}12.86 vs. Vitamin D LTG 17.97±}9.15; F=0.171, P=0.680). There was no statistically significant difference in the average values of OCLN between the CBZ and LTG groups (OCLN CBZ 26.06±}10.87 vs. OCLN LTG 27.87±}28.45; F=0.171, P=0.674). The BMD value was lower in both groups using antiepileptic agents compared to the controls, but when comparing the CBZ group to the LTG group, a statistically significant difference was only observed for the Z score (T-score CBZ: 0.08±} 1.38 vs. T-score LTG: 0.37±} 1.02; F=1.495, P=0.224; Z score CBZ: -0.05±}1.17 vs. Z. Score CBZ: 0.38±}0.96; F=4.069, P=0.046) (Table 3).</p><strong>Conclusion</strong>. The choice of antiepileptic agents for treating seizures in patients with brain tumors should be carefully evaluated in relation to their impact on bone health. These patients could benefit from supplementation and regular measurement of biochemical markers of bone turnover and BMD.

scholarly journals P1621VITAMIN D SUPPLEMENTATION: CHANGES IN BONE MINERAL DENSITY IN KIDNEY TRANSPLANT PATIENTS WITH LONG TERM DURATION OF THE GRAFT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yuri Battaglia ◽  
Michele Provenzano ◽  
Francesco Tondolo ◽  
Antonio Bellasi ◽  
Pasquale Esposito ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Kidney Transplant ◽  
Bone Mineral ◽  
Categorical Variables ◽  
Z Score ◽  
Mineral Density ◽  
T Score

Abstract Background and Aims In the medical literature, several studies have linked bone mineral density (BMD) with vitamin D deficiency in kidney transplant patients (KTRs). However, in spite of the fact that ergocalciferol, cholecalciferol and calcifediol reduce parathyroid hormone (PTH) and improves calcium levels, their effects on the bone mineral density (BMD) in KTRs remain undefined. In consideration of the lack of data available, we aim at investigating the effect of inactive form of vitamin D supplementation on the BMD over a follow-up period up to 2 year, in a real-life cohort of long-term kidney transplant(KT). Method This study was carried out in KTRs who were followed up in a Nephrology Unit. Exclusion criteria were parathyroidectomy, therapy with bisphosphonate, previous history of bone fractures. Demographic, clinical and immunosuppressive agents were collected. Based on 25-OH-D levels, KTRs were classified as suffering from deficiency (&lt; 30 ng/mL). BMD was evaluated at lumbar vertebral bodies (LV) and right femoral hip (FH) by a single operator, using a standard dual energy X-ray absorptiometry. According to WHO criteria, results were expressed as T-score (standard deviation [SD] relative to young healthy adults), and Z-score (SD relative to age-matched controls). Osteoporosis and osteopenia were defined as T score ≤ −2.5 SD and T score &lt; −1 and &gt; −2.5 SD, respectively. Laboratory data, 25-OH-D, and BMD were measured at baseline and after 24 months of supplementation therapy. Vitamin D deficiency was corrected using standard treatment strategy recommended for general population. Continuous variables were expressed as mean ± SD whereas categorical variables as percentage. The Student’s t test and chi-square test were used to compare to compare continuous and categorical variables, respectively. For before and after comparisons of continuous variables, the paired t-test or one-sample Wilcoxon signed rank test were used based on variable’s distribution. Results Data pertaining to 111 out of 133 consecutive outpatients were collected, of whom most were males (69.4%), no-smokers (89.1%) and treated with glucocorticoids (84%). The mean age was 53.9±11.6 years and months after transplant was 161.6±128.3. No statistical differences were found among patients with normal BMD, osteopenia or osteoporosis at LV and FH in terms of age at transplant, gender distribution, time on dialysis, BMI and eGFR, serum calcium, serum phosphate, 25-OH-D and iPTH. At baseline, 25-OH-D was 13.9±7.2 ng/ml and the prevalence of osteopenia/osteoporosis was 40.9% (T-Score -1.69±0.37; Z-score -1.16±1.09) and 21.8 % (T-Score -3.15±0.50; Z-score -2.27±0.58) at LV; 55.3 % (T-Score -1.8±0.46; Z-score -0.84±0.633) and 14 % (T-Score -2.83±0.39; Z-score -1.65±0.49) at FH. After 27.6±3.7 months of therapy with cholecalciferol at mean dose of 13.396±7.537 UI at week, 25-OH-D values increased to 29.4±9.4 ng/ml (p&lt;0.0001) while no statistically significant changes were found in Z-score and T-score at both sites, except for a mild improvement in lumbar vertebral Z-score, reaching −0.82± 0.7 (p = 0.06) in KTRs with osteopenia Conclusion Our study showed BMD remained stable after up to 2 years of inactive vitamin D therapy in long-term kidney transplant with vitamin D deficiency. A mild increase in Z-score was observed in the L-spine. Further designated studies should be conducted to demonstrate the effect of vitamin D on BMD.

Relationship between calcium metabolism and benign paroxysmal positional vertigo in north Sardinia population

2020 ◽  
Vol 30 (6) ◽  
pp. 375-382
Author(s):  
Andrea Melis ◽  
Davide Rizzo ◽  
Roberto Gallus ◽  
Maria Eleonora Leo ◽  
Nicola Turra ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Benign Paroxysmal Positional Vertigo ◽  
High Accuracy ◽  
T Score ◽  
Positional Vertigo ◽  
Vitamin D Levels ◽  
The Impact ◽  
Paroxysmal Positional Vertigo ◽  
Group 1

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) has a reported recurrence ranging from 26.8 to 50%. Osteoporosis and Vitamin D deficiency seems to have an impact on recurrence of BPPV. OBJECTIVE: to evaluate the impact of osteoporosis and Vitamin D deficiency on recurrence of BPPV. METHODS: 73 consecutive patients were divided in two groups according to the presence (group 1) or absence (group 0) of a recurrent episode. BMD, femoral and lumbar T-scores and Vitamin D levels were recorded. Statistical analysis was performed to investigate correlations. RESULTS: patients in group 1 had statistically significant lower values of both femoral (–1,62±1,06 vs. –0,53±1,51; p = 0,001), lumbar T-score (–2,10±1,19 vs –0, 53±1.51, p = 0.001) and Vitamin D (19.53±15.33). The values of femoral T-score and Vitamin D could be combined in a model able to properly classify 65.8% of the cases (p = 0.002) as isolated or recurrent BPPV, with high accuracy (AUC 0.710 [0.590 –0.830]). CONCLUSION: present data show a probable correlation between osteoporosis and Vitamin D with recurrent BPPV.

Decreased Bone Mineral Density among Patients with Hemophilia.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1153-1153
Author(s):  
Gregory Gerstner ◽  
Mary Lou Damiano ◽  
Angela Tom ◽  
Christina Worman ◽  
Wendy Schultz ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Alkaline Phosphatase ◽  
Femoral Neck ◽  
Bone Mineral ◽  
Hiv Positive ◽  
Severe Hemophilia ◽  
Mineral Density ◽  
T Score ◽  
Vitamin D Levels

Abstract Background: Osteoporosis among adult males is a major and under-recognized problem in the United States. Patients with hemophilia have several predisposing risks for developing decreased bone mineral density (BMD) and osteoporosis, and may represent an important group to target for screening and treatment for fracture prevention. Patients and Methods: Patients over the age of 18 with moderate or severe hemophilia A or B (as defined by factor activity < 5%) and no history of prophylactic factor use prior to age 10 were eligible. Bone mineral densities were obtained using DEXA scans (DXA) along with measurements of joint mobility and physical activity and laboratory parameters. Results: Twenty-eight patients have been consented with accrual ongoing. 21 have undergone DXA scans. Median age of 39 (range 18–61), 86% HCV positive, 26% HIV positive. Median T-score for all sites (lumbar, femoral neck, hip, and other) was −1.7 (−5.8–0.6), with the most effected area being the femoral neck, T-score −1.7 (−5.8–0.8). Based on WHO criteria, 76% of patients had decreased BMD, 33% (n=7) with osteoporosis, and 43% (n=9) with osteopenia. Trends associated with decreased BMD included decreased serum 25-hydroxy-vitamin D levels, increased alkaline phosphatase, and decreased weight. All patients with osteoporosis were HCV positive, and all HIV positive patients had decreased BMD. Median activity scores were lower among osteoporotic patients vs normal BMD. Joint range-of-motion in the lower extremities was limited to 59.5% of predicted values in patients with osteoporosis, 84% in osteopenia, and 93% in patients with normal BMD. Summary: Patients with hemophilia are at markedly increased risk for developing osteoporosis and osteopenia. Potential predictors of risk for decreased BMD are concurrent HCV and HIV infection, low vitamin D levels, elevated alkaline phosphatase, lower weight, decreased range of motion and lower activity scores. More aggressive screening for decreased BMD among moderate and severe hemophilia patients with initiation of therapy is appropriate. Median Values Worst T-Score Activity Score (1–5) Joint ROM (% Pred) Weight (kg) 25-Hydroxy-D (ng/mL) Alk Phos (IU/L) Normal BMD 0.1 5 94.0 91.6 28.0 59 Osteopenia −1.6 4 85.0 80.7 23.0 86 Osteoporosis −3.0 3 68.5 73.0 21.8 99

scholarly journals MON-344 Uncommon Etiology of Hypophosphatemia and Secondary Hyperparathyroidism: Ferric Carboxymaltose Infusion

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sakine Sever
Keyword(s):  
Vitamin D ◽  
Secondary Hyperparathyroidism ◽  
Spinal Stenosis ◽  
Side Effect ◽  
Deficiency Anemia ◽  
Ferric Carboxymaltose ◽  
Left Femur ◽  
T Score ◽  
Fgf 23 ◽  
Work Up

Abstract Background: Hypophosphatemia has been recognized as one of the side effect of intravenous ferric carboxymaltose infusion. This effect is thought to be secondary to fibroblast growth factor 23 (FGF 23) mediated renal phosphate wasting and associated with calcitriol deficiency and secondary hyperparathyroidism. Clinical Case: A 76 years old male patient with medical problems including hypertension, type 2 diabetes mellitus, hyperlipidemia, paroxysmal atrial fibrillation, nephrolithiasis, spinal stenosis and chronic anemia was referred to endocrinology clinic for osteoporosis management. Bone density scan showed left femur neck T-score of -2.5 and L1-L4 lumbar spine T-score of 1.4. He reported pain on back and bilateral posterior thighs, difficulty with ambulation which were partly attributed to severe spinal stenosis that he was planned to have surgery for. Muscle strength was normal on examination. Laboratory studies were obtained for osteoporosis work up and showed: Calcium: 8.9 mg/dL (8.8-10.2 mg/dL), Creatinine: 0.77 mg/dL (0.74-1.35 mg/dL), GFR: 88 mL/min/BSA, Albumin 4.5 g/dL (3.5-5.0 g/dL), 25-Hydroxy vitamin D: 26 ng/mL, Magnesium 1.8 mg/dL (1.7-2.3 mg/mL), 1,25 Dihydroxy Vitamin D 24 pg/mL (18-64 pg/mL), Phosphorus: 1 mg/dL (2.5-4.5 mg/dL), PTH 163 pg/mL (15-65 pg/mL), Hemoglobin 12.9 mg/dL (13.2-16.6 mg/dL). Due to hypophosphatemia tumor induced osteomalacia diagnosis was entertained and further work up was considered in this regard however later noted that patient received ferric carboxymaltose 750 mg infusion two times within last 3 weeks for iron deficiency anemia. Hemoglobin level was 8.6 mg/dL before the infusions. After oral phosphate replacement the phosphate level improved to 2.4 mg/dL. Serum FGF 23 level was measured and it was normal at 108 RU/mL (&lt;180 RU/mL). He was then started on bisphosphonate treatment for osteoporosis. Conclusion: Hypophosphatemia and secondary hyperparathyroidism can be seen after ferric carboxymaltose infusion due to FGF-23 mediated mechanism. In literature various presentations were reported from transient- asymptomatic hypophosphatemia to severe acute symptomatic hypophosphatemia along with persistent hypophosphatemia with osteomalacia and fragility fractures due to recurrent ferric carboxymaltose infusions. Thus, one should keep this possible side effect in mind during evaluation of hypophosphatemia and osteoporosis. References: 1. Wolf M, Chertow GM, Macdougall IC, Kaper R, Krop J, Strauss W. Randomized trial of intravenous iron-induced hypophosphatemia. JCI Insight. Dec 6 2018;3(23):e124486 2. Fang W, McMahon LP, Bloom S, Garg M. Symptomatic severe hypophosphatemia after intravenous ferric carboxymaltose. JGH Open. October 2019, volume 3, issue 5, P 438-440

Medikamentöse Therapie der renalen Osteopathie unter Berücksichtigung sozialmedizinischer Aspekte

2008 ◽  
Vol 17 (03) ◽  
pp. 159-164
Author(s):  
H. J. Deuber
Keyword(s):  
Vitamin D ◽  
Medikamentöse Therapie

ZusammenfassungZur Therapie des sekundären Hyperparathyreoidismus infolge einer Niereninsuffizienz und der damit verbundenen renalen Osteopathie stehen neben den Phosphatbindern Vitamin D und Vitamin D(-Metaboliten) sowie Kalzium-Rezeptor-“Sensitizer” (Cinacalcet) als Arzneimittel zur Verfügung. Abhängig davon, ob diese als apothekenpflichtige oder als verschreibungspflichtige Arzneimittel deklariert sind, müssen bei der Verordnung dieser Medikamente im Rahmen der vertragsärztlichen Versorgung der Patienten unterschiedliche Vorschriften beachtet werden. Zusätzlich muss beachtet werden, dass auch wirkstoffgleiche Arzneimittel in unterschiedlichen Indikationen zugelassen sind, was deren Verordnungsfähigkeit im Rahmen der vertragsärztlichen Versorgung je nach der jeweils zugelassenen Indikation einschränkt.

Die Osteoporose des Mannes

2007 ◽  
Vol 27 (06) ◽  
pp. 323-327 ◽  
Author(s):  
J. D. Ringe
Keyword(s):  
Vitamin D ◽  
Medikamentöse Therapie ◽  
Medikamentöse Behandlung ◽  
Körperliche Untersuchung

ZusammenfassungDie Bedeutung der Osteoporose des Mannes nimmt rasant zu. Fast jeder fünfte Osteoporose-Patient in der Praxis ist heute bereits ein Mann. Die Diagnose wird jedoch zu selten gestellt und die wenigen bislang therapierten Fälle werden oft falsch oder inkonsequent behandelt. Als Verdachtsmomente auf das Vorliegen einer Osteoporose sind unklare Rückenbeschwerden, Größenabnahme, Rundrücken, Kalksalzminderung im Röntgenbild und gehäufte Frakturen einzeln genommen unsichere Kriterien. Eine eindeutige Diagnosestellung ist jedoch durch Anamnese und körperliche Untersuchung, Osteodensitometrie und Röntgen der Wirbelsäule sowie ergänzende Laborparameter einfach zu bewerkstelligen. Wie bei der postmenopausalen Osteoporose beinhaltet die Therapiestrategie Basistherapie (insbesondere Calcium/Vitamin D Substitution), Schmerz-therapie und spezifisch medikamentöse Therapie zur Reduktion des Knochenumbaus bzw. Stimulation des Knochen- anbaus. Die spezifische medikamentöse Behandlung ist weniger gut wissenschaftlich evaluiert als bei Frauen. Außer Raloxifen und Östrogen/Gestagen kommen jedoch prinzipiell die gleichen Therapeutika in Betracht. Therapie der ersten Wahl sind die oral zu verabreichenden Bisphosphonate. Zugelassene Substanzen für die Indikation Osteoporose des Mannes sind Alendronat und Risedro- nat - bei schweren Osteoporosen auch dasTeriparatid. Die Androgentherapie sollte jüngeren Männeren mit eindeutigem Hypogonadismus vorbehalten bleiben und muss bei ausgeprägter Osteopenie evtl. durch gleichzeitige Behandlung mit anderen antiresorptiven oder osteoanabolen Medikamenten verstärkt werden.

Influence of the levels of vitamin D on T-score in HIP measured by DXA of colombian postmenopausal women

2018 ◽  
Author(s):  
Richard Buendia ◽  
Santiago Cardenas ◽  
Monica Zambrano ◽  
Andres Buendia ◽  
Maria De Los Angeles Varon ◽  
...  
Keyword(s):  
Vitamin D ◽  
Postmenopausal Women ◽  
T Score
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