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Arthritis und Rheuma 2006; 26(04): 232-238
DOI: 10.1055/s-0037-1620066
Knochen und Muskeln
Schattauer GmbH

Pharmakologische Intervention an Muskel und Knochen

Pharmacologic intervention in muscle and bone
Dieter Felsenberg
1   Zentrum Muskel- und Knochenforschung, Charité – Campus Benjamin Franklin Freie und Humboldt-Universität Berlin
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Publication History

Publication Date:
23 December 2017 (online)

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Zusammenfassung

Die Therapie von Knochen und Muskeln im Zusammenhang mit der Osteoporose hat zwei wesentliche Zielpunkte: 1. Ein weiterer Knochenabbau soll verhindert und, wenn möglich, soll ein neuer Knochen wieder aufgebaut werden. 2. Die Muskulatur muss gekräftigt werden, damit der Knochen durch einen zunehmenden Verformungs-Impuls zum Modelling angeregt wird und durch verbesserte Koordination/ Balance das Sturzrisiko vermindert wird. Demzufolge muss eine moderne, suffiziente Therapie der Osteoporose einer Strategie entsprechen, die beide Organsystem gleichermaßen berücksichtigt. Zur Behandlung des Knochens empfehlen die Leitlinien des Dachverbandes deutsprachiger wissenschaftlicher Gesellschaften für Osteologie (DVO; http://lutherhaus.de/osteo/leitlinien-dvo/) Antiresorptiva wie Alendronat, Ibandronat, Raloxifen und Risedronat und Osteoanabolika wie Teriparatid und Strontium-Ranelat, wobei letztgenannte Substanz sowohl antiresorptiv als auch osteoanabol wirkt. Immer soll, soweit es die Evidenzen der klinischen Interventionsstudien nahe legen, der Patient und die Patientin gleichzeitig ausreichend mit Kalzium und Vitamin D3 versorgt werden.

Auch die Therapie der Muskulatur kann pharmakologisch erfolgen, wobei nicht primär an androgene Anabolika gedacht wird, sondern eher an Substanzen wie natives Vitamin D3 oder die aktiven D-Hormone wie Alfacalcidol oder Kalzitriol. Die Evidenzen sind aber noch recht schwach und diese Therapieformen haben daher noch keine Berücksichtigung in den Leitlinien des DVO gefunden. Anders sieht es mit dem Muskeltraining aus als Knochenstimulus und zur Sturzrisiko-Reduktion. Zur Kombination von Knochen- und Muskeltherapie bei der Osteoporose fehlen aber noch klinische Evidenzen. Es besteht somit Forschungsbedarf.

Summary

The therapy of bones and muscles in osteoporotic patients aspire two different objectives: 1. Maintain bone and reduce bone resorption, increase formation of new bone with a strong structure. 2. Increase muscle force to generate minimal effective strain to stimulate bone modelling and to reduce risk of falls by improvement of balance and muscle coordination. Consequently, a modern strategy to treat osteoporosis must include therapy of bone and muscle. According to the guidelines of the German osteological societies (DVO), bone should be treated with antiresorptive compounds like alendronate, ibandronate, raloxifene, and risedronate as well with osteoanabolic compounds like teriparatide and strontium-ranelate. The latter compound is acting antiresorptive as well as osteoanabolic. Calcium and vitamin D3 supplementation is mandatory, according to the evidences of the pivotal studies.

Pharmacological treatment of the muscle is limited to naive vitamin D3 or D-hormones like alfacalcidol or Calcitriol. Anabolic compounds like androgens are not recommended because of the adverse events. The evidences of alfacalcidol und calcitriol are increasing but finally not ready for recommendation by DVO guidelines. This is different to the suggestions concerning physical muscle training to stimulate bone formation and to reduce risk of falls. The strategy of combined treatment of bone and muscle in osteoporosis has low evidences so far as well. Clinical studies are needed.

Schlüsselwörter

Therapie - Osteoporose - Frakturrisiko - Sturzrisiko - Antiresorptiva - Osteoanabolika

Keywords

Therapy - osteoporosis - fracture risk - fall risk - antiresorptive compounds - osteoanabolic compounds
 

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