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. 2022 Feb;81(1):57-66.
doi: 10.1007/s00393-021-01127-8. Epub 2022 Jan 7.

[Glucocorticoid-induced osteoporosis-Focus treatment (part 1)]

[Article in German]
Peter Oelzner  1 , T Eidner  2 , A Pfeil  2
Affiliations

[Glucocorticoid-induced osteoporosis-Focus treatment (part 1)]

[Article in German]
Peter Oelzner et al. Z Rheumatol. 2022 Feb.

Abstract
in English, German

With a fracture prevalence of 30-50%, glucocorticoid (GC)-induced osteoporosis is one of the most important comorbidities in inflammatory rheumatic diseases. Because of a reduction of bone quality with a lack of correlation with bone mineral density, the fracture risk during long-term GC treatment is not sufficiently represented by the currently available methods of osteodensitometry and therefore underestimated. According to the Confederation for Osteology (DVO) guidelines, a baseline osteological diagnosis including osteodensitometry is indicated in all postmenopausal women and in men aged 60 years and older who receive or are scheduled to receive GC at a dose of ≥ 2.5 mg prednisolone equivalent/day for > 3 months. Basic measures in GC-treated patients include vitamin D and calcium supplementation as well as measures to promote muscle strength and coordination and to prevent falls. The indications for a specific osteological treatment depend on the calculated GC dose, age, sex, and other fracture risk factors in addition to bone mineral density and prevalent fractures.

Mit einer Frakturprävalenz von 30–50 % zählt die Glukokortikoid(GK)-induzierte Osteoporose zu den wichtigsten Komorbiditäten bei entzündlich rheumatischen Erkrankungen. Aufgrund einer Verminderung der Knochenqualität mit fehlender Korrelation zur Knochenmineraldichte wird das Frakturrisiko unter Langzeit-GK-Therapie mit den derzeit eingesetzten Verfahren der Osteodensitometrie nur unzureichend abgebildet und daher unterschätzt. Eine osteologische Basisdiagnostik einschließlich Osteodensitometrie ist nach DVO(Dachverband Osteologie)-Leitlinie bei allen postmenopausalen Frauen und bei Männern ab dem 60. Lebensjahr indiziert, die GK in einer Dosis von ≥ 2,5 mg Prednisolonäquivalent/Tag für > 3 Monate erhalten oder erhalten sollen. Basismaßnahmen bei GK-behandelten Patienten sind Vitamin-D- und Kalziumsubstitution sowie Maßnahmen zur Förderung von Muskelkraft und Koordination und zur Sturzprophylaxe. Die Indikationsstellung für eine spezifische osteologische Therapie ist neben der Knochenmineraldichte und prävalenten Frakturen abhängig von kalkulierter GK-Dosis, Alter, Geschlecht und weiteren Frakturrisikofaktoren.

Keywords: Basic measures; Bone mineral density; Diagnostics; Fracture risk; Osteological treatment.

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References

Literatur

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