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Frauenheilkunde up2date 2016; 10(03): 203-218
DOI: 10.1055/s-0042-108054
Gynäkologische Endokrinologie und Reproduktionsmedizin
Georg Thieme Verlag KG Stuttgart · New York

Osteoporose in der Gynäkologie – Diagnostik und Therapie

Heide Siggelkow
,
Peyman Hadji
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Publikationsverlauf

Publikationsdatum:
22. Juni 2016 (online)

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Kernaussagen

  • Jede prämenopausale amenorrhoische Frau hat prinzipiell ein Risiko für eine Fraktur.

  • Besonders hoch ist das Risiko nach Chemotherapie, unter Aromataseinhibitor- oder GnRH-Therapie ± Tamoxifen.

  • Eine Knochendichtemessung mittels DXA-Methode ist individuell indiziert, aber nur bei einem erhöhten Gesamtfrakturrisiko > 20 % eine Kassenleistung.

  • Im Vordergrund steht auf jeden Fall die Minimierung von Risikofaktoren.

  • Je nach Alter, Knochendichtemessung und Risikofaktoren ist eine spezifische Therapie indiziert.

  • Bei Schwangeren mit akut aufgetretenen Rückenschmerzen (insbesondere bei Größenabnahme, starken lokalisierten Schmerzen und bei fortgesetzten Beschwerden) sollte auf das mögliche Auftreten von Frakturen geachtet werden.

  • Bei Frauen mit einer Anorexie sollte v. a. eine ernährungsbedingte Gewichtszunahme erfolgen. Zusätzlich scheint eine Therapie mit 17-β-Östradiol die Knochendichte zu erhalten.

 

  • Literatur

  • 1 Hadji P, Klein S, Gothe H et al. The epidemiology of osteoporosis – Bone Evaluation Study (BEST): an analysis of routine health insurance data. Dtsch Arztebl Int 2013; 110: 52-57
    Google Scholar
  • 2 WHO. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 1994; 843: 1-129
    Google Scholar
  • 3 Cooper C, Atkinson EJ, Jacobsen SJ et al. 3rd population-based study of survival after osteoporotic fractures. Am J Epidemiol 1993; 137: 1001-1005
    CrossrefGoogle Scholar
  • 4 Kanis JA, Adachi JD, Cooper C et al. Standardising the descriptive epidemiology of osteoporosis: recommendations from the Epidemiology and Quality of Life Working Group of IOF. Osteoporos Int 2013; 2013: 25
    Google Scholar
  • 5 DVO e.V.. Leitlinie Osteoporose 2014. Internet: http://www.dv-osteologie.org/dvo_leitlinien/osteoporose-leitlinie-2014 Stand: 04.05.2016
    Google Scholar
  • 6 Ismail AA, Cockerill W, Cooper C et al. Prevalent vertebral deformity predicts incident hip though not distal forearm fracture: results from the European Prospective Osteoporosis Study. Osteoporos Int 2001; 12: 85-90
    CrossrefGoogle Scholar
  • 7 Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39: 142-148
    CrossrefPubMedGoogle Scholar
  • 8 Guralnik JM, Ferrucci L, Simonsick EM et al. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995; 332: 556-561
    CrossrefGoogle Scholar
  • 9 Gluer CC, Eastell R, Reid DM et al. Association of five quantitative ultrasound devices and bone densitometry with osteoporotic vertebral fractures in a population-based sample: the OPUS Study. J Bone Mineral Res 2004; 19: 782-793
    CrossrefGoogle Scholar
  • 10 Schott AM, Kassai Koupai B, Hans D et al. Should age influence the choice of quantitative bone assessment technique in elderly women? The EPIDOS study. Osteoporos Int 2004; 15: 196-203
    CrossrefGoogle Scholar
  • 11 Michaelsson K, Melhus H, Warensjo Lemming E et al. Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study. Br Med J 2013; 346: f228
    Google Scholar
  • 12 Warensjo E, Byberg L, Melhus H et al. Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study. Br Med J 2011; 342: d1473
    CrossrefGoogle Scholar
  • 13 Tsai KS, Heath 3rd H, Kumar R, Riggs BL. Impaired vitamin D metabolism with aging in women. Possible role in pathogenesis of senile osteoporosis. J Clin Invest 1984; 73: 1668-1672
    CrossrefGoogle Scholar
  • 14 Max Rubner-Institut. Vitamin D. Karlsruhe: Max Rubner-Institut; 2008
    Google Scholar
  • 15 Siggelkow H. [Vitamin D and old age]. MMW Fortschr Med 2007; 149: 36-37
    Google Scholar
  • 16 Cauley JA, Robbins J, Chen Z et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Womenʼs Health Initiative randomized trial. J Am Med Assoc 2003; 290: 1729-1738
    CrossrefGoogle Scholar
  • 17 Silverman SL, Chines AA, Kendler DL et al. Sustained efficacy and safety of bazedoxifene in preventing fractures in postmenopausal women with osteoporosis: results of a 5-year, randomized, placebo-controlled study. Osteoporos Int 2012; 23: 351-363
    CrossrefGoogle Scholar
  • 18 Cauley JA, Norton L, Lippman ME et al. Continued breast cancer risk reduction in postmenopausal women treated with raloxifene: 4-year results from the MORE trial. Multiple outcomes of raloxifene evaluation. Breast Cancer Res Treat 2001; 65: 125-134
    CrossrefGoogle Scholar
  • 19 Martino S, Cauley JA, Barrett-Connor E et al. Continuing outcomes relevant to Evista: breast cancer incidence in postmenopausal osteoporotic women in a randomized trial of raloxifene. J Nat Cancer Instit 2004; 96: 1751-1761
    Google Scholar
  • 20 Lippman ME, Cummings SR, Disch DP et al. Effect of raloxifene on the incidence of invasive breast cancer in postmenopausal women with osteoporosis categorized by breast cancer risk. Clin Cancer Res 2006; 12: 5242-5247
    CrossrefGoogle Scholar
  • 21 Khan AA, Morrison A, Hanley DA et al. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Mineral Res 2015; 30: 3-23
    CrossrefGoogle Scholar
  • 22 Adler RA, El-Hajj Fuleihan G, Bauer DC et al. Managing osteoporosis in patients on long-term bisphosphonate treatment: report of a task force of the American Society for Bone and Mineral Research. J Bone Mineral Res 2016; 31: 16-35
    CrossrefGoogle Scholar
  • 23 Bredella MA, Fazeli PK, Miller KK et al. Increased bone marrow fat in anorexia nervosa. J Clin Endocrinol Metab 2009; 94: 2129-2136
    CrossrefGoogle Scholar
  • 24 Misra M, Klibanski A. Anorexia nervosa and bone. J Endocrin 2014; 221: R163-R176
    CrossrefGoogle Scholar
  • 25 Misra M. Long-term skeletal effects of eating disorders with onset in adolescence. Ann N Y Acad Sci 2008; 1135: 212-218
    CrossrefGoogle Scholar
  • 26 Vescovi JD, Jamal SA, De Souza MJ. Strategies to reverse bone loss in women with functional hypothalamic amenorrhea: a systematic review of the literature. Osteoporos Int 2008; 19: 465-478
    CrossrefGoogle Scholar
  • 27 Misra M, Tsai P, Anderson EJ et al. Nutrient intake in community-dwelling adolescent girls with anorexia nervosa and in healthy adolescents. Am J Clin Nutr 2006; 84: 698-706
    Google Scholar
  • 28 Seeman E, Szmukler GI, Formica C et al. Osteoporosis in anorexia nervosa: the influence of peak bone density, bone loss, oral contraceptive use, and exercise. J Bone Mineral Res 1992; 7: 1467-1474
    Google Scholar
  • 29 Golden NH, Lanzkowsky L, Schebendach J et al. The effect of estrogen-progestin treatment on bone mineral density in anorexia nervosa. J Pediatr Adolsecent Gyn 2002; 15: 135-143
    Google Scholar
  • 30 Klibanski A, Biller BM, Schoenfeld DA et al. The effects of estrogen administration on trabecular bone loss in young women with anorexia nervosa. J Clin Endocrinol Metab 1995; 80: 898-904
    CrossrefPubMedGoogle Scholar
  • 31 Strokosch GR, Friedman AJ, Wu SC et al. Effects of an oral contraceptive (norgestimate/ethinyl estradiol) on bone mineral density in adolescent females with anorexia nervosa: a double-blind, placebo-controlled study. J Adolesc Health 2006; 39: 819-827
    CrossrefPubMedGoogle Scholar
  • 32 Misra M, Katzman D, Miller KK et al. Physiologic estrogen replacement increases bone density in adolescent girls with anorexia nervosa. J Bone Mineral Res 2011; 26: 2430-2438
    CrossrefGoogle Scholar
  • 33 DiVasta AD, Gordon CM. Hormone replacement therapy for the adolescent patient. Ann NY Acad Sci 2008; 1135: 204-211
    CrossrefGoogle Scholar
  • 34 Warren MP, Chua AT. Exercise-induced amenorrhea and bone health in the adolescent athlete. Ann NY Acad Sci 2008; 1135: 244-252
    CrossrefGoogle Scholar
  • 35 Wisser J, Florio I, Neff M et al. Changes in bone density and metabolism in pregnancy. Acta Obstet Gynecol Scand 2005; 84: 349-354
    CrossrefGoogle Scholar
  • 36 Lanham SA, Roberts C, Cooper C et al. Intrauterine programming of bone. Part 1: Alteration of the osteogenic environment. Osteoporos Int 2007; 19: 147-156
    Google Scholar
  • 37 Lanham SA, Roberts C, Perry MJ et al. Intrauterine programming of bone. Part 2: Alteration of skeletal structure. Osteoporos Int 2007; 19: 157-167
    Google Scholar
  • 38 Kovacs CS. Calcium and bone metabolism during pregnancy and lactation. J Mammary Gland Biol Neoplasia 2005; 10: 105-118
    CrossrefGoogle Scholar
  • 39 Mahadevan S, Kumaravel V, Bharath R. Calcium and bone disorders in pregnancy. Indian J Endocrinol Metab 2012; 16: 358-363
    CrossrefGoogle Scholar
  • 40 Wagner CL, McNeil RB, Johnson DD et al. Health characteristics and outcomes of two randomized vitamin D supplementation trials during pregnancy: a combined analysis. J Steroid Biochem Mol Biol 2013; 136: 313-320
    CrossrefPubMedGoogle Scholar
  • 41 Zittermann A. The estimated benefits of vitamin D for Germany. Mol Nutr Food Res 2010; 54: 1164-1171
    Google Scholar
  • 42 Wuertz C, Gilbert P, Baier W et al. Cross-sectional study of factors that influence the 25-hydroxyvitamin D status in pregnant women and in cord blood in Germany. Br J Nutr 2013; 110: 1895-1902
    CrossrefGoogle Scholar
  • 43 Hellmeyer L, Ossendorf A, Ziller V et al. Quantitative ultrasonometry of the phalanges during pregnancy: a longitudinal study. Climacteric 2006; 9: 446-451
    CrossrefGoogle Scholar
  • 44 Hellmeyer L, Kuhnert M, Ziller V et al. The use of i.v. bisphosphonate in pregnancy-associated osteoporosis – case study. Experiment Clin Endocrinol Diab 2007; 115: 139-142
    Google Scholar
  • 45 Steib-Furno S, Mathieu L, Pham T et al. Pregnancy-related hip diseases: incidence and diagnoses. Joint Bone Spine 2007; 74: 373-378
    CrossrefGoogle Scholar
  • 46 Hellmeyer L, Ziller V, Anderer G et al. Biochemical markers of bone turnover during pregnancy: a longitudinal study. Experiment Clin Endocrinol Diab 2006; 114: 506-510
    Google Scholar
  • 47 OʼSullivan SM, Grey AB, Singh R et al. Bisphosphonates in pregnancy and lactation-associated osteoporosis. Osteoporos Int 2006; 17: 1008-1012
    CrossrefGoogle Scholar
  • 48 Hellmeyer L, Boekhoff J, Hadji P. Treatment with teriparatide in a patient with pregnancy-associated osteoporosis. Gynecol Endocrinol 2010; 26: 725-728
    CrossrefGoogle Scholar
  • 49 Eastell R. Aromatase inhibitors and bone. J Steroid Biochem Mol Biol 2007; 106: 157-161
    CrossrefGoogle Scholar
  • 50 Mincey BA, Duh MS, Thomas SK et al. Risk of cancer treatment-associated bone loss and fractures among women with breast cancer receiving aromatase inhibitors. Clin Breast Cancer 2006; 7: 127-132
    CrossrefGoogle Scholar
  • 51 Hadji P, Body JJ, Aapro MS et al. Practical guidance for the management of aromatase inhibitor-associated bone loss. Ann Oncol 2008; 19: 1407-1416
    CrossrefGoogle Scholar
  • 52 Hillner BE, Ingle JN, Chlebowski RT et al. American Society of Clinical Oncology 2003 update on the role of bisphosphonates and bone health issues in women with breast cancer. J Clin Oncol 2003; 21: 4042-4057
    CrossrefGoogle Scholar
  • 53 Hadji P, Aapro MS, Body JJ et al. Management of aromatase inhibitor-associated bone loss in postmenopausal women with breast cancer: practical guidance for prevention and treatment. Ann Oncol 2011; 22: 2546-2555
    CrossrefGoogle Scholar
  • 54 Reid DM, Doughty J, Eastell R et al. Guidance for the management of breast cancer treatment-induced bone loss: a consensus position statement from a UK Expert Group. Cancer Treat Rev 2008; 34 (Suppl. 01) S3-S18
    Google Scholar
  • 55 Rizzoli R, Body JJ, DeCensi A et al. Guidance for the prevention of bone loss and fractures in postmenopausal women treated with aromatase inhibitors for breast cancer: an ESCEO position paper. Osteoporos Int 2012; 23: 2567-2576
    CrossrefGoogle Scholar
  • 56 Becorpi A, Sisti G, Sorbi F et al. Management options of breast cancer related osteoporosis. Clin Cases Miner Bone Metab 2014; 11: 110-113
    Google Scholar
  • 57 Coleman R, Body JJ, Aapro M et al. Bone health in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol 2014; 25 (Suppl. 03) iii124-iii137
    CrossrefGoogle Scholar
  • 58 Coleman RE, Lipton A, Roodman GD et al. Metastasis and bone loss: advancing treatment and prevention. Cancer Treat Rev 2010; 36: 615-620
    CrossrefGoogle Scholar
  • 59 Gnant M, Pfeiler G, Dubsky PC et al. Adjuvant denosumab in breast cancer (ABCSG-18): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2015; 386: 433-443
    CrossrefGoogle Scholar
  • 60 Aapro M, Abrahamsson PA, Body JJ et al. Guidance on the use of bisphosphonates in solid tumours: recommendations of an international expert panel. Ann Oncol 2007; 19: 420-432
    CrossrefGoogle Scholar
  • 61 Ziller V, Kostev K, Kyvernitakis I et al. Persistence and compliance of medications used in the treatment of osteoporosis – analysis using a large scale, representative, longitudinal German database. Int J Clin Pharmacol Ther 2012; 50: 315-322
    CrossrefGoogle Scholar
  • 62 Coleman R, de Boer R, Eidtmann H et al. Zoledronic acid (zoledronate) for postmenopausal women with early breast cancer receiving adjuvant letrozole (ZO-FAST study): final 60-month results. Ann Oncol 2013; 24: 398-405
    CrossrefGoogle Scholar