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DOI: 10.1055/a-2053-7004
Kapitel Basistherapie: Kalzium, Vitamin D und K, Ernährung, Körperliches Training
Chapter Primary Prevention: Calcium, Vitamin D and K, Nutrition, Physical ActivityZusammenfassung
In diesem Artikel wird der aktuelle Stand der DVO-Leitlinienempfehlungen zur Basistherapie vorgestellt. Die Basistherapie ist die Grundlage jeder Osteoporosebehandlung und ist auch für die Primärprävention von entscheidender Bedeutung, noch bevor die Knochenmineraldichte niedrig ist oder Frakturen auftreten. Auf der Grundlage einer aktualisierten Literaturrecherche umfasst das Kapitel Empfehlungen zu Kalzium, Vitamin D, Vitamin K und anderen Ernährungsaspekten sowie zu körperlicher Aktivität. Frühere Empfehlungen wurden überprüft und auf der Grundlage der neuen Literatur ergänzt. Die Empfehlungen für die Einnahme von Kalzium und Vitamin D, situationsabhängig entweder über die Ernährung oder über Supplemente, bleiben unverändert. Vitamin K wird nur zum Ausgleich eines Mangels empfohlen, da die Datenlage für eine Empfehlung in anderen Bereichen wie der allgemeinen Frakturprävention zu inkonsistent ist. Körperliche Aktivität hat einen positiven Effekt auf das Frakturrisiko und die Knochendichte und ist daher auch weiterhin eine wichtige Empfehlung, idealerweise im Rahmen eines angepassten, supervidierten Trainingsprogramms.
Abstract
This article presents the current status of the DVO guideline recommendations on basic therapy. Basic therapy is the foundation of any osteoporosis management and is also vital to its primary prevention; even before bone mineral density is low, or fractures occur. Based on an updated literature review, the chapter covers recommendations on calcium, vitamin D, vitamin K and other nutritional aspects as well as physical activity. Previous recommendations were reviewed and amended based on the new literature. Recommendations on calcium and vitamin D intake, through diet or supplements, remain unchanged. Vitamin K is recommended only to compensate for a deficiency, since data are too inconsistent for a recommendation in other settings such as fracture prevention. Physical activity has a positive effect on fracture risk and bone mineral density and therefore continues to be an important recommendation, also recommended, ideally in an appropriate supervised training program.
Publication History
Received: 11 January 2023
Accepted: 07 March 2023
Article published online:
25 May 2023
© 2023. Thieme. All rights reserved.
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Literatur
- 1 Chung M, Tang AM, Fu Z et al. Calcium Intake and Cardiovascular Disease Risk: An Updated Systematic Review and Meta-analysis. Ann Intern Med. 2016; 165: 856–866
- 2 Al-Bishri J, Attar S, Bassuni N. et al. Comorbidity profile among patients with rheumatoid arthritis and the impact on prescriptions trend. Clin Med Insights Arthritis Musculoskelet Disord 2013; 6: 11-18 DOI: 10.4137/cmamd.S11481.
- 3 Lewiecki EM. Safety of long-term bisphosphonate therapy for the management of osteoporosis. Drugs 2011; 71: 791-814 DOI: 10.2165/11585470-000000000-00000.
- 4 Carmel AS, Shieh A, Bang H. et al. The 25(OH)D level needed to maintain a favorable bisphosphonate response is≥33 ng/ml. Osteoporos Int 2012; 23: 2479-2487 DOI: 10.1007/s00198-011-1868-7.
- 5 Díez-Pérez A, Olmos JM, Nogués X. et al. Risk factors for prediction of inadequate response to antiresorptives. J Bone Miner Res 2012; 27: 817-824 DOI: 10.1002/jbmr.1496.
- 6 Liu C, Kuang X, Li K. et al. Effects of combined calcium and vitamin D supplementation on osteoporosis in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials. Food Funct 2020; 11: 10817-10827 DOI: 10.1039/d0fo00787k.
- 7 Dai Z, McKenzie JE, McDonald S. et al. Assessment of the Methods Used to Develop Vitamin D and Calcium Recommendations-A Systematic Review of Bone Health Guidelines. Nutrients 2021; 13 DOI: 10.3390/nu13072423.
- 8 Kimball SM, Holick MF. Official recommendations for vitamin D through the life stages in developed countries. Eur J Clin Nutr 2020; 74: 1514-1518 DOI: 10.1038/s41430-020-00706-3.
- 9 Bilezikian JP, Formenti AM, Adler RA. et al. Vitamin D: Dosing, levels, form, and route of administration: Does one approach fit all?. Rev Endocr Metab Disord 2021; 22: 1201-1218 DOI: 10.1007/s11154-021-09693-7.
- 10 Sanders KM, Stuart AL, Williamson EJ. et al. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. Jama 2010; 303: 1815-1822 DOI: 10.1001/jama.2010.594.
- 11 Smith H, Anderson F, Raphael H. et al. Effect of annual intramuscular vitamin D on fracture risk in elderly men and women – a population-based, randomized, double-blind, placebo-controlled trial. Rheumatology (Oxford) 2007; 46: 1852-1857 DOI: 10.1093/rheumatology/kem240.
- 12 Mazess RB, Bischoff-Ferrari HA, Dawson-Hughes B. Vitamin D: Bolus Is Bogus-A Narrative Review. JBMR Plus 2021; 5: e10567 DOI: 10.1002/jbm4.10567.
- 13 Bischoff-Ferrari HA. [Hype about vitamin D substitution: what remains?]. Internist (Berl) 2020; 61: 1196-1203 DOI: 10.1007/s00108-020-00869-y.
- 14 Simes DC, Viegas CSB, Araújo N. et al. Vitamin K as a Diet Supplement with Impact in Human Health: Current Evidence in Age-Related Diseases. Nutrients 2020; 12 DOI: 10.3390/nu12010138.
- 15 Popa DS, Bigman G, Rusu ME. The Role of Vitamin K in Humans: Implication in Aging and Age-Associated Diseases. Antioxidants (Basel) 2021; 10 DOI: 10.3390/antiox10040566.
- 16 Mladěnka P, Macáková K, Kujovská Krčmová L. et al. Vitamin K – sources, physiological role, kinetics, deficiency, detection, therapeutic use, and toxicity. Nutr Rev 2022; 80: 677-698 DOI: 10.1093/nutrit/nuab061.
- 17 Sato T, Inaba N, Yamashita T. MK-7 and Its Effects on Bone Quality and Strength. Nutrients 2020; 12 DOI: 10.3390/nu12040965.
- 18 Mandatori D, Pelusi L, Schiavone V. et al. The Dual Role of Vitamin K2 in “Bone-Vascular Crosstalk”: Opposite Effects on Bone Loss and Vascular Calcification. Nutrients 2021; 13 DOI: 10.3390/nu13041222.
- 19 Stock M, Schett G. Vitamin K-Dependent Proteins in Skeletal Development and Disease. Int J Mol Sci 2021; 22 DOI: 10.3390/ijms22179328.
- 20 Zhang Y, Bala V, Mao Z. et al. A concise review of quantification methods for determination of vitamin K in various biological matrices. J Pharm Biomed Anal 2019; 169: 133-141 DOI: 10.1016/j.jpba.2019.03.006.
- 21 Fusaro M, Gallieni M, Rizzo MA. et al. Vitamin K plasma levels determination in human health. Clin Chem Lab Med 2017; 55: 789-799 DOI: 10.1515/cclm-2016-0783.
- 22 Hu L, Ji J, Li D. et al. The combined effect of vitamin K and calcium on bone mineral density in humans: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2021; 16: 592 DOI: 10.1186/s13018-021-02728-4.
- 23 Mott A, Bradley T, Wright K. et al. Effect of vitamin K on bone mineral density and fractures in adults: an updated systematic review and meta-analysis of randomised controlled trials. Osteoporos Int 2019; 30: 1543-1559 DOI: 10.1007/s00198-019-04949-0.
- 24 Mott A, Bradley T, Wright K. et al. Correction to Effect of vitamin K on bone mineral density and fractures in adults: an updated systematic review and meta-analysis of randomised controlled trials. Osteoporos Int 2020; 31: 2269-2270 DOI: 10.1007/s00198-020-05586-8.
- 25 Su S, He N, Men P. et al. The efficacy and safety of menatetrenone in the management of osteoporosis: a systematic review and meta-analysis of randomized controlled trials. Osteoporos Int 2019; 30: 1175-1186 DOI: 10.1007/s00198-019-04853-7.
- 26 Su S, He N, Men P. et al. Correction to: The efficacy and safety of menatetrenone in the management of osteoporosis: a systematic review and meta-analysis of randomized controlled trials. Osteoporos Int 2021; 32: 2141-2142 DOI: 10.1007/s00198-021-06053-8.
- 27 Rønn SH, Harsløf T, Oei L. et al. The effect of vitamin MK-7 on bone mineral density and microarchitecture in postmenopausal women with osteopenia, a 3-year randomized, placebo-controlled clinical trial. Osteoporos Int 2021; 32: 185-191 DOI: 10.1007/s00198-020-05638-z.
- 28 Rønn SH, Harsløf T, Pedersen SB. et al. Vitamin K2 (menaquinone-7) prevents age-related deterioration of trabecular bone microarchitecture at the tibia in postmenopausal women. Eur J Endocrinol 2016; 175: 541-549 DOI: 10.1530/eje-16-0498.
- 29 Ruan J, Gong X, Kong J. et al. Effect of B vitamin (folate, B6, and B12) supplementation on osteoporotic fracture and bone turnover markers: a meta-analysis. Med Sci Monit 2015; 21: 875-881 DOI: 10.12659/msm.893310.
- 30 Enneman AW, Swart KM, van Wijngaarden JP. et al. Effect of Vitamin B12 and Folic Acid Supplementation on Bone Mineral Density and Quantitative Ultrasound Parameters in Older People with an Elevated Plasma Homocysteine Level: B-PROOF, a Randomized Controlled Trial. Calcif Tissue Int 2015; 96: 401-409 DOI: 10.1007/s00223-015-9968-6.
- 31 Lambert H, Frassetto L, Moore JB. et al. The effect of supplementation with alkaline potassium salts on bone metabolism: a meta-analysis. Osteoporos Int 2015; 26: 1311-1318 DOI: 10.1007/s00198-014-3006-9.
- 32 Liu Y, Liu JP, Xia Y. Chinese herbal medicines for treating osteoporosis. Cochrane Database Syst Rev 2014; DOI: 10.1002/14651858.CD005467.pub2:. Cd005467. doi:10.1002/14651858.CD005467.pub2
- 33 Malmir H, Shab-Bidar S, Djafarian K. Vitamin C intake in relation to bone mineral density and risk of hip fracture and osteoporosis: a systematic review and meta-analysis of observational studies. Br J Nutr 2018; 119: 847-858 DOI: 10.1017/s0007114518000430.
- 34 Zhao R, Feng F, Wang X. Exercise interventions and prevention of fall-related fractures in older people: a meta-analysis of randomized controlled trials. Int J Epidemiol 2017; 46: 149-161 DOI: 10.1093/ije/dyw142.
- 35 Chan DC, Chang CB, Han DS. et al. Effects of exercise improves muscle strength and fat mass in patients with high fracture risk: A randomized control trial. J Formos Med Assoc 2018; 117: 572-582 DOI: 10.1016/j.jfma.2017.05.004.
- 36 Shojaa M, von Stengel S, Kohl M. et al. Effects of dynamic resistance exercise on bone mineral density in postmenopausal women: a systematic review and meta-analysis with special emphasis on exercise parameters. Osteoporos Int 2020; 31: 1427-1444 DOI: 10.1007/s00198-020-05441-w.
- 37 Zitzmann AL, Shojaa M, Kast S. et al. The effect of different training frequency on bone mineral density in older adults. A comparative systematic review and meta-analysis. Bone 2022; 154: 116230 DOI: 10.1016/j.bone.2021.116230.