Osteoporose in der Gynäkologie – Diagnostik und Therapie

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.

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