Therapieansätze bei querschnittassoziierter Osteoporose

Zusammenfassung

Menschen mit chronischer, motorisch kompletter Querschnittlähmung weisen einen ausgeprägten subläsionalen Abbau der Knochenmineraldichte auf. Die klinische Bedeutung dieses Knochenabbaus liegt in einem erhöhten Risiko für Frakturen der unteren Extremitäten. Daher ist es von klinischer Relevanz, die Knochenfragilität bei Querschnittgelähmten zu reduzieren. Richtlinien für die Therapie einer querschnittassoziierten Osteoporose sind bislang ausstehend. Daher ist es das Ziel der Arbeitsgruppe Osteoporose der Deutschsprachigen Medizinischen Gesellschaft für Paraplegie (DMGP), in diesem Artikel entsprechende Empfehlungen zu formulieren. Basierend auf wissenschaftlichen Studien kann der Einsatz eines Elektrostimulationinduzierten Fahrradtrainings zur Therapie einer Osteoporose in den unteren Extremitäten von Personen mit chronischer Querschnittlähmung erwogen werden. Die Gabe von Bisphosphonat in Kombination mit Kalzium scheint zudem das Potenzial zu haben, die Knochenresorption bei Männern mit chronischer Querschnittlähmung zu reduzieren. Es muss beachtet werden, dass diese Empfehlungen auf einer beschränkten Studienlage basieren. Weiterführende Studien sind demzufolge notwendig, um insbesondere die Empfehlung für eine Anwendung von Bisphosphonat zur Therapie einer querschnittassoziierten Osteoporose zu erhärten.

Summary

Individuals with chronic motor and sensory complete spinal cord injury (SCI) suffer from a distinct sublesional bone loss. The clinical relevance of this sublesional bone loss consists of an increased risk for lower extremity fractures. Therefore, the reduction of bone fragility in individuals with SCI is of clinical importance. So far, recommendations for the therapy of osteoporosis in individuals with SCI are missing. It is therefore the aim of the osteoporosis working group of the German speaking medical society for paraplegia (DMGP) to formulate recommendations in this regard. Based on the literature, the use of electrostimulation-induced cycling training (at least three times a week) can be considered an effective therapy for SCI related osteoporosis. The administration of bisphosphonates in combination with calcium and vitamin D seems to have the potential to reduce bone resorption. However, these recommendations are based on limited knowledge, i. e. observation periods of up to two years and small numbers of participants (up to 26 in the interventional group). Therefore, further studies are needed, particularly to confirm the effectiveness of bisphosphonates for the treatment of SCI related osteoporosis.

Schlüsselwörter

Querschnittlähmung - Osteoporose - Elektrostimulation - Bisphosphonate

Keywords

Spinal cord injury - osteoporosis - electrical stimulation - bisphosphonates

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