Advertisement

Zeitschrift für Gerontologie und Geriatrie

, Volume 52, Issue 5, pp 433–439 | Cite as

Osteoporose und Multimorbidität

  • S. WickleinEmail author
  • M. Gosch
Themenschwerpunkt
  • 122 Downloads

Zusammenfassung

Osteoporose ist eine systemische Knochenerkrankung, die durch verminderte Knochenfestigkeit zu einem erhöhten Frakturrisiko prädisponiert. Gerade ältere Patienten weisen ein hohes Risiko für Fragilitätsfrakturen auf. Bei diesen Patienten reicht die isolierte Betrachtung der Osteoporose nicht aus; vielmehr sollte diese im Kontext der Multimorbidität gesehen werden. Verschiedene Erkrankungen sind mit Osteoporose assoziiert, sei es durch pathophysiologische Mechanismen, gemeinsame Risikofaktoren oder aufgrund ihrer pharmakologischen Therapie. Auch geriatrische Syndrome wie etwa Sturzneigung spielen eine wesentliche Rolle. Dieser Beitrag gibt einen Überblick über Multimorbiditätsinteraktionen anhand ausgewählter häufiger Erkrankungen im höheren Lebensalter und zeigt das Vorgehen in der klinischen Praxis.

Schlüsselwörter

Knochenfrakturen Knochendichte Komorbidität Akzidentelle Stürze Medikation 

Osteoporosis and multimorbidity

Abstract

Osteoporosis is a systemic bone disease with decreased bone strength and mass resulting in an increased predisposition to fracture risk. Especially older patients have a high risk for fragility fractures. In these patients an isolated view of osteoporosis without consideration of multimorbidity is insufficient. Various diseases are associated with osteoporosis because of shared pathophysiological mechanisms, risk factors or as a consequence of medication. Furthermore, geriatric syndromes, such as falls play an importance role. This article presents an overview about multimorbidity interactions based on selected frequent diseases in older age and shows the management in the clinical practice.

Keywords

Fractures, bone Bone density Comorbidity Accidental falls Medication 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

S. Wicklein und M. Gosch geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Literatur

  1. 1.
    Bartl R, Bartl C, Gradinger R (2010) Medikamenteninduzierte Osteopathien. Medikamente, Pathogenese, Formen, Diagnostik, Prävention und Therapie. Z Rheumatol 69:135–150CrossRefGoogle Scholar
  2. 2.
    Bolland MJ, Ames RW, Horne AM, Orr-Walker BJ, Gamble GD, Reid IR (2007) The effect of treatment with a thiazide diuretic for 4 years on bone density in normal postmenopausal women. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 18:479–486Google Scholar
  3. 3.
    Botolin S, McCabe LR (2006) Chronic hyperglycemia modulates osteoblast gene expression through osmotic and non-osmotic pathways. J Cell Biochem 99:411–424CrossRefGoogle Scholar
  4. 4.
    Boyd CM, Vollenweider D, Puhan MA (2012) Informing evidence-based decision-making for patients with comorbidity: availability of necessary information in clinical trials for chronic diseases. PLoS ONE 7:e41601CrossRefGoogle Scholar
  5. 5.
    Brown JS, Vittinghoff E, Wyman JF et al (2000) Urinary Incontinence: Does it Increase Risk for Falls and Fractures? J Am Geriatr Soc 48:721–725CrossRefGoogle Scholar
  6. 6.
    Carbone L, Buzková P, Fink HA et al (2010) Hip fractures and heart failure: findings from the Cardiovascular Health Study. Eur Heart J 31:77–84CrossRefGoogle Scholar
  7. 7.
    Carbone LD, Cross JD, Raza SH et al (2008) Fracture risk in men with congestive heart failure risk reduction with spironolactone. J Am Coll Cardiol 52:135–138CrossRefGoogle Scholar
  8. 8.
    Carbone LD, Johnson KC, Bush AJ et al (2009) Loop diuretic use and fracture in postmenopausal women: findings from the Women’s Health Initiative. Arch Intern Med 169:132–140CrossRefGoogle Scholar
  9. 9.
    Caughey GE, Roughead EE, Vitry AI, McDermott RA, Shakib S, Gilbert AL (2010) Comorbidity in the elderly with diabetes: Identification of areas of potential treatment conflicts. Diabetes Res Clin Pract 87:385–393CrossRefGoogle Scholar
  10. 10.
    Chhokar VS, Sun Y, Bhattacharya SK et al (2004) Loss of bone minerals and strength in rats with aldosteronism. American journal of physiology. Am J Physiol 287:H2023–6Google Scholar
  11. 11.
    Colón-Emeric C, O’Connell MB, Haney E (2011) Osteoporosis piece of multi-morbidity puzzle in geriatric care. Mt Sinai J Med 78:515–526CrossRefGoogle Scholar
  12. 12.
    Cummings SR, San Martin J, McClung MR et al (2009) Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 361:756–765CrossRefGoogle Scholar
  13. 13.
    Dobnig H, Piswanger-Sölkner JC, Roth M et al (2006) Type 2 diabetes mellitus in nursing home patients: effects on bone turnover, bone mass, and fracture risk. J Clin Endocrinol Metab 91:3355–3363CrossRefGoogle Scholar
  14. 14.
    dvo leitlinie osteoporoseGoogle Scholar
  15. 15.
    Ezekowitz JA (2010) A new pathway? Failure, fragility and fractures. Eur Heart J 31:9–11CrossRefGoogle Scholar
  16. 16.
    Fink HA, Kuskowski MA, Taylor BC, Schousboe JT, Orwoll ES, Ensrud KE (2008) Association of Parkinson’s disease with accelerated bone loss, fractures and mortality in older men: the Osteoporotic Fractures in Men (MrOS) study. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the. USA, Bd. 19, S 1277–1282Google Scholar
  17. 17.
    Gerber Y, Melton LJ, Weston SA, Roger VL (2011) Osteoporotic fractures and heart failure in the community. Am J Med 124:418–425CrossRefGoogle Scholar
  18. 18.
    Gosch M, Jeske M, Kammerlander C, Roth T (2012) Osteoporosis and polypharmacy. Z Gerontol Geriatr 45:450–454CrossRefGoogle Scholar
  19. 19.
    Hamann C, Goettsch C, Mettelsiefen J et al (2011) Delayed bone regeneration and low bone mass in a rat model of insulin-resistant type 2 diabetes mellitus is due to impaired osteoblast function. American journal of physiology. Am J Physiol 301:E1220–8Google Scholar
  20. 20.
    Haney EM, Chan BKS, Diem SJ et al (2007) Association of low bone mineral density with selective serotonin reuptake inhibitor use by older men. Arch Intern Med 167:1246–1251CrossRefGoogle Scholar
  21. 21.
    Häussler B, Gothe H, Göl D, Glaeske G, Pientka L, Felsenberg D (2007) Epidemiology, treatment and costs of osteoporosis in. USA, Bd. 18. the BoneEVA Study. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the, Germany, S 77–84Google Scholar
  22. 22.
    Herrmann M, Tami A, Wildemann B et al (2009) Hyperhomocysteinemia induces a tissue specific accumulation of homocysteine in bone by collagen binding and adversely affects bone. Bone 44:467–475CrossRefGoogle Scholar
  23. 23.
    Ionescu AA, Schoon E (2003) Osteoporosis in chronic obstructive pulmonary disease. European Respiratory Journal 22:64s–75sGoogle Scholar
  24. 24.
    Kahn SE, Zinman B, Lachin JM et al (2008) Rosiglitazone-associated fractures in type 2 diabetes: an Analysis from A Diabetes Outcome Progression Trial (ADOPT). Diabetes Care 31:845–851CrossRefGoogle Scholar
  25. 25.
    Kim SM, Long J, Montez-Rath M, Leonard M, Chertow GM (2016) Hip Fracture in Patients With Non-Dialysis-Requiring Chronic Kidney Disease. J Bone Miner Res 31:1803–1809CrossRefGoogle Scholar
  26. 26.
    Lazoura O, Papadaki PJ, Antoniadou E et al (2010) Skeletal and body composition changes in hemiplegic patients. J Clin Densitom 13:175–180CrossRefGoogle Scholar
  27. 27.
    Lechleitner M, Pils K, Roller-Wirnsberger R et al (2013) Diabetes und Osteoporose: Pathophysiologische Interaktionen und klinische Bedeutung für geriatrische Patienten. Z Gerontol Geriatr 46:390–397CrossRefGoogle Scholar
  28. 28.
    Leslie WD, Rubin MR, Schwartz AV, Kanis JA (2012) Type 2 diabetes and bone. J Bone Miner Res 27:2231–2237CrossRefGoogle Scholar
  29. 29.
    Liao K‑M, Lu H‑Y (2016) A National Analysis of Complications Following Total Hip Replacement in Patients With Chronic Obstructive Pulmonary Disease. Medicine 95:e3182CrossRefGoogle Scholar
  30. 30.
    Lim LS, Fink HA, Kuskowski MA, Taylor BC, Schousboe JT, Ensrud KE (2008) Loop diuretic use and increased rates of hip bone loss in older men: the Osteoporotic Fractures in Men Study. Arch Intern Med 168:735–740CrossRefGoogle Scholar
  31. 31.
    Lui L‑Y, Stone K, Cauley JA, Hillier T, Yaffe K (2003) Bone Loss Predicts Subsequent Cognitive Decline in Older Women: The Study of Osteoporotic Fractures. J Am Geriatr Soc 51:38–43CrossRefGoogle Scholar
  32. 32.
    Lynn H, Kwok T, Wong SYS, Woo J, Leung PC (2006) Angiotensin converting enzyme inhibitor use is associated with higher bone mineral density in elderly Chinese. Bone 38:584–588CrossRefGoogle Scholar
  33. 33.
    Magaziner J, Wehren L, Hawkes WG et al (2006) Women with hip fracture have a greater rate of decline in bone mineral density than expected: another significant consequence of a common geriatric problem. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, Bd. 17, S 971–977Google Scholar
  34. 34.
    Meersch M, Schmidt C, Zarbock A (2016) Patient with chronic renal failure undergoing surgery. Curr Opin Anaesthesiol 29:413–420CrossRefGoogle Scholar
  35. 35.
    Mikosch P (2012) Diagnose von Osteoporose beim geriatrischen Patienten: Möglichkeiten und Grenzen. Wien Med Wochenschr 162:99–109CrossRefGoogle Scholar
  36. 36.
    Montagnani A, Gonnelli S (2013) Antidiabetic therapy effects on bone metabolism and fracture risk. Diabetes Obes Metab 15:784–791CrossRefGoogle Scholar
  37. 37.
    Motola D, Piccinni C, Biagi C et al (2012) Cardiovascular, ocular and bone adverse reactions associated with thiazolidinediones: a disproportionality analysis of the US FDA adverse event reporting system database. Drug Saf 35:315–323CrossRefGoogle Scholar
  38. 38.
    Neumann T, Sämann A, Lodes S et al (2011) Glycaemic control is positively associated with prevalent fractures but not with bone mineral density in patients with Type 1 diabetes. Diabetic medicine : a journal of the British Diabetic. Association 28:872–875Google Scholar
  39. 39.
    Nuño-Solinis R, Rodríguez-Pereira C, Alonso-Morán E, Orueta JF (2014) Comorbidity and Healthcare Expenditure in Women with Osteoporosis Living in the Basque Country (Spain). J Osteoporos 2014:1–7CrossRefGoogle Scholar
  40. 40.
    Patsch JM, Kiefer FW, Varga P et al (2011) Increased bone resorption and impaired bone microarchitecture in short-term and extended high-fat diet-induced obesity. Metab Clin Exp 60:243–249CrossRefGoogle Scholar
  41. 41.
    Pietschmann P, Patsch JM, Schernthaner G (2010) Diabetes and bone. Horm Metab Res 42:763–768CrossRefGoogle Scholar
  42. 42.
    Pijpers E, Ferreira I, de Jongh RT et al (2012) Older individuals with diabetes have an increased risk of recurrent falls: analysis of potential mediating factors: the Longitudinal Ageing Study Amsterdam. Age Ageing 41:358–365CrossRefGoogle Scholar
  43. 43.
    Pouwels S, Lalmohamed A, Leufkens B et al (2009) Risk of hip/femur fracture after stroke: a population-based case-control study. Stroke 40:3281–3285CrossRefGoogle Scholar
  44. 44.
    Puth M‑T, Klaschik M, Schmid M, Weckbecker K, Münster E (2018) Prevalence and comorbidity of osteoporosis—a cross-sectional analysis on 10,660 adults aged 50 years and older in Germany. BMC Musculoskelet Disord 19:144CrossRefGoogle Scholar
  45. 45.
    Reid IR (1993) Steroid osteoporosis. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the. USA, Bd. 3, S 144–146Google Scholar
  46. 46.
    Roche JJW, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. Clin Res Ed 331:1374CrossRefGoogle Scholar
  47. 47.
    Salive ME (2013) Multimorbidity in older adults. Epidemiol Rev 35:75–83CrossRefGoogle Scholar
  48. 48.
    Schlienger RG, Kraenzlin ME, Jick SS, Meier CR (2004) Use of beta-blockers and risk of fractures. JAMA 292:1326–1332CrossRefGoogle Scholar
  49. 49.
    Schneider JL, Fink HA, Ewing SK, Ensrud KE, Cummings SR (2008) The association of Parkinson’s disease with bone mineral density and fracture in older women. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, Bd. 19, S 1093–1097Google Scholar
  50. 50.
    Stolee P, Poss J, Cook RJ, Byrne K, Hirdes JP (2009) Risk factors for hip fracture in older home care clients. The journals of gerontology. Series A. J Gerontol A Biol Sci Med Sci 64:403–410CrossRefGoogle Scholar
  51. 51.
    Taylor BC, Schreiner PJ, Stone KL et al (2004) Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures. J Am Geriatr Soc 52:1479–1486CrossRefGoogle Scholar
  52. 52.
    Tofthagen C, Visovsky C, Berry DL (2012) Strength and balance training for adults with peripheral neuropathy and high risk of fall: current evidence and implications for future research. Oncol Nurs Forum 39:E416–24CrossRefGoogle Scholar
  53. 53.
    Valsamis HA, Arora SK, Labban B, McFarlane SI (2006) Antiepileptic drugs and bone metabolism. Nutr Metab 3:36CrossRefGoogle Scholar
  54. 54.
    van den Bos F, Speelman AD, Samson M, Munneke M, Bloem BR, Verhaar HJJ (2013) Parkinson’s disease and osteoporosis. Age Ageing 42:156–162CrossRefGoogle Scholar
  55. 55.
    van den Brand MWM, Pouwels S, Samson MM et al (2009) Use of anti-depressants and the risk of fracture of the hip or femur. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the. USA, Bd. 20, S 1705–1713Google Scholar
  56. 56.
    Yaffe K, Browner W, Cauley J, Launer L, Harris T (1999) Association Between Bone Mineral Density and Cognitive Decline in Older Women. J Am Geriatr Soc 47:1176–1182CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Medizinische Klinik 2 – Schwerpunkt Geriatrie, Universitätsklinik für GeriatrieParacelsus Medizinische Privatuniversität, Campus NürnbergNürnbergDeutschland

Personalised recommendations