Verlaufsdiagnostik des Knochenstoffwechsels unter verschiedenen Therapieformen

Zusammenfassung

Osteoporose ist per se eine chronische Erkrankung, daher sind neben nichtpharmakologischen Interventionen (z. B. hinsichtlich Ernährung und Bewegung) vor allem medikamentöse Behandlungen durch Antiresorptiva, osteoanabole oder dual wirksame Medikamente im individuellen Kontext für viele Jahre zu planen. Für ein Langzeit-Monitoring dieser Therapien kommen bildgebende Verfahren wie die Knochendichtemessung, Risiko-Algorithmen, aber auch die Messung von Knochenstoffwechselmarkern in Betracht. Während Knochendichtemessungen aufgrund der nur langsamen Umstellung der Knochenstruktur und -dichte in mehrjährigen Abständen sinnvoll sind, ermöglichen Labormessungen als Surrogatmarker eine Momentaufnahme des individuellen Knochenumsatzes und die Beurteilung der Medikamentenwirkung oder eines Risikos bei Therapiepause in wesentlich kürzeren Abständen und mit wenig Aufwand. Im Folgenden werden Labormarker des Knochenstoffwechsels in Hinblick auf Langzeittherapie, Kombinations- oder Sequenztherapie und das Management von Therapiepausen hin beleuchtet, um individuelle Behandlungsstrategien für Osteoporose-Betroffene planen und kontrollieren zu können. Dabei wird auch auf spezielle Personengruppen bzw. sekundäre Formen von Osteoporose eingegangen und auf neue Entwicklungen für die Zukunft des Osteoporose-Monitorings hingewiesen.

Abstract

Osteoporosis is per se a chronic disease, requiring non-pharmacological interventions such as nutritional and training adaptations, but also a long-term use of bone-specific pharmacological treatments, including antiresorptive and/or osteoanabolic or even dual approaches. Imaging options such as bone density measurements, risk algorithms and the assessment of bone turnover are necessary for the monitoring of such therapies. While bone density measurements during monitoring of treatment are only useful in more than annual intervals due to the slow reaction of bone structure and density to therapeutic interventions, lab-based analyses of bone turnover are surrogate markers for individual “flash-lights” of bone metabolism and easy-to-access information in shorter intervals of choice. This review aims to discuss markers of bone metabolism in view of long-term strategies, combination and sequential therapy and the management of drug holidays as a tool to monitor individual reactions and needs of pharmacological therapy options. Specific patient groups or secondary forms of osteoporosis will be discussed as well as new developments for the future monitoring of patients with osteoporosis.

Schlüsselwörter

Osteoporose - medikamentöse Therapie - Monitoring - Knochenumsatzmarker

Key words

Osteoporosis - pharmacological therapy - monitoring - bone turnover markers

Publikationsverlauf

Eingereicht: 14. Juni 2023

Angenommen: 13. September 2023

Artikel online veröffentlicht:
05. Oktober 2023

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