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Osteologie 2019; 28(04): 274-277
DOI: 10.1055/a-0999-9798
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Der Schlaganfall als Risikofaktor für osteoporotische Frakturen

Stroke as risk factor for osteoporotic fractures
Petra Benzinger
1   Geriatrisches Zentrum am Bethanien Krankenhaus Heidelberg, Universität Heidelberg
2   Hochschule Kempten, Fakultät Soziales und Gesundheit, Kempten
,
Jürgen M Bauer
1   Geriatrisches Zentrum am Bethanien Krankenhaus Heidelberg, Universität Heidelberg
› Author Affiliations
Further Information

Publication History

08/02/2019

08/20/2019

Publication Date:
14 November 2019 (online)

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Zusammenfassung

Im Rahmen der demographischen Entwicklung in Deutschland nimmt die Zahl der Personen, welche einen Schlaganfall erleiden, stetig zu. Überlebende eines Schlaganfalls haben im Vergleich zur altersgleichen Bevölkerung ein erhöhtes Risiko, eine Fragilitätsfraktur zu erleiden. Für Personen über 65 Jahre mit Schlaganfall wurde eine Inzidenz von 33,6 Frakturen pro 1000 Personenjahre berechnet im Vergleich zu 21,4 pro 1000 Personenjahre in der altersgleichen Bevölkerung. Ursachen sind hier die erhöhte Sturzneigung sowie eine Verminderung der Knochendichte auf der paretischen Seite. Das Risiko für eine sturzbedingte Fraktur ist dabei abhängig von der wiedererlangten Selbständigkeit. Personen mit anhaltendem Pflegebedarf weisen daher ein deutlich erhöhtes Frakturrisiko auf. In Ermangelung einer ausreichenden spezifischen Evidenz für diese Risikogruppe sollten die Empfehlungen zur Sturzprävention für ambulant lebende Menschen berücksichtigt werden. Hier ist insbesondere ein Gleichgewichtstraining in Kombination mit einem Krafttraining anzuraten. Die Indikation zu einer Basisdiagnostik nach DVO Leitlinie sollte unter besonderer Berücksichtigung des Sturzrisikos überprüft werden. Bei Personen mit einer residuellen Hemiparese sollte die DXA Messung auf der paretischen Seite erfolgen.

Abstract

Due to demographic changes the number of persons suffering from stroke is steadily increasing. Compared to persons of their age stroke survivors have an increased risk to sustain a fragility fracture. The incidence rate of a fracture in stroke survivors aged 65 years and older was estimated to 33.6 fractures per 1,000 person-years compared to 21.4 fractures per 1,000 person-years in an age-matched control group. Fracture risk in stroke survivors is driven by their increased risk to fall and the decreased bone mineral density on the paretic side. Falls risk is strongly influenced by a patient’s recovery of independence in activities of daily living. Consequently, persons with a care need after stroke have a particularly high fracture risk. Due to the paucity of specific evidence for stroke survivors general recommendations for fall prevention should be offered to this high risk population. In particular, fall prevention programs including training of strength and balance offer the greatest benefit. Screening for osteoporosis should be offered according to the DVO guideline with particular consideration of the individual fall risk and measurements of bone mineral density should be performed on the paretic side based.

Schlüsselwörter

Schlaganfall - Osteoporose - Stürze - Frakturen

Key words

Stroke - osteoporosis - falls - fractures
 

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