Die Osteoporose des Mannes

Zusammenfassung

Der männlichen Osteoporose liegt häufig eine sekundäre Osteoporose zugrunde. Die niedrige Knochendichte mit Veränderungen der Mikroarchitektur des Knochens, die zu Fragilitätsfrakturen führt, wird dabei meist durch eine zugrunde liegende Erkrankung oder Medikation verursacht. Das Vorliegen einer männlichen Osteoporose muss insbesondere dann vermutet werden, wenn Fragilitätsfrakturen bei jungen Männern auftreten oder geringe Knochendichtewerte vorliegen. Es sollte zunächst eine ausführliche Krankengeschichte erhoben werden und eine klinische Untersuchung mit Basis-Labordiagnostik erfolgen. Dadurch können klinische Risikofaktoren, osteoporoseinduzierende Medikamente, ursächliche endokrine, gastroenterologische, hämatologische oder rheumatische Erkrankungen erkannt und mit spezifischeren Untersuchungen bestätigt werden. Die Knochendichtemessung mittels DXA-Messung an der Hüfte und der Wirbelsäule ist der entscheidende und wegweisende diagnostische Test. Zum Nachweis bereits eingetretener Wirbelkörperfrakturen empfiehlt sich eine Röntgenuntersuchung der Wirbelsäule (Brustwirbelsäule/Lendenwirbelsäule) in zwei Ebenen. Die Therapie der sekundären Osteoporose beinhaltet neben der spezifischen antiresorptiven Therapie immer die Therapie der zugrunde liegenden Erkrankung,insbesondere aber die Beendigung oder Modifikation osteoporosefördernder Medikamente.

Summary

Osteoporosis in men is frequently of a secondary nature. Low bone mineral density (BMD) and alterations to the skeletal microarchitecture, which cause fragility fractures, are commonly caused by an underlying disease or concurrent medication. Osteoporosis in men should be suspected after fractures without adequate trauma, after fracture in young men or a very low BMD in men younger than 60 years. A detailed medical history and physical examination should be followed by a standard laboratory evaluation. Thereby, one can frequently identify risk factors for osteoporosis such as, drugs associated with osteoporosis or endocrine, gastrointestinal, hematologic, or rheumatologic diseases. Evaluation of BMD using DXA at the hip and the spine is regarded as the gold standard for the diagnosis of osteoporosis. Spinal X-rays should be performed to exclude vertebral fractures. Therapy of secondary osteoporosis in men includes the treatment of the underlying disease, modification of osteoporosis-promoting drug therapy, adequate vitamin D and calcium intake, and specific anti-osteoporotic therapy.

Schlüsselwörter

Frakturen - Glukokortikoide - Immunsuppression - Männer - Osteoporose

Keywords

Fractures - glucocorticoids - immunosuppression - male - osteoporosis

^* C. Hamann und E. Tsourdi haben zu gleichen Teilen beigetragen

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