Glukokortikoid-induzierte Osteoporose: ein Update

 

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Zusammenfassung

Die Glukokortikoid-induzierte Osteoporose ist die häufigste sekundäre Osteoporoseform und beim jungen Erwachsenen die häufigste Ursache einer Osteoporose überhaupt. Der Einsatz von oralen Glukokortikoiden bedingt einen Verlust an Knochenmasse mit erhöhter Frakturhäufigkeit bereits in den ersten drei Monaten der Therapie. Eine untere Dosisgrenze scheint es nicht zu geben: Auch niedrige Tagesdosen von 2,5 mg Prednisolonäquivalent erhöhen das Frakturrisiko, wenn auch in geringerem Umfang. Eine adäquate Diagnostik bei Vorliegen von Risikofaktoren und ein rechtzeitiger Therapiebeginn vermögen das Frakturrisiko deutlich zu senken. Dieser Artikel soll die Pathophysiologie und die aktuellen diagnostisch-therapeutischen Empfehlungen einschließlich der kürzlich aktualisierten Leitlinie des Dachverbandes Osteologie (DVO) zusammenfassen.

Abstract

Glucocorticoid-induced osteoporosis is the most common cause of secondary osteoporosis. Moreover, it is the most common reason for an osteoporosis among young adults. The clinical use of oral glucocorticoids increases the fracture incidence already within three months after starting the therapy. There does not seem to be a lower threshold: even doses as low as 2,5 mg of prednisone equivalent increase the risk of fractures. Adequate diagnostic and therapy are able to significantly reduce the resulting fracture risk. This article will discuss the pathophysiology of glucocorticoid-induced osteoporosis and give a summary of the current recommendations including the recently updated German guidelines.

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