Chronisch entzündliche Darmerkrankungen und Osteoporose

Zusammenfassung

Die vorliegende Publikation ist mit dem Ziel erstellt worden, den engen Zusammenhang zwischen chronisch entzündlichen Darmerkrankungen (CED) und dem gleichzeitig häufigen Auftreten einer Osteopenie bzw. Osteoporose darzustellen. Hierbei ist das Aufzeigen multipler Risikofaktoren bei CED für eine Knochendichteminderung wie auch für das hiermit verknüpfte deutlich erhöhte Frakturrisiko ein wichtiges Anliegen. Wege der Prävention osteoporosebedingter Frakturen wie auch das mögliche Therapiespektrum einer Osteoporosebehandlung werden aufgezeigt. Dies ist umso wichtiger, als es sich bei CED-Patienten häufig um junge Patienten handelt, die bereits früh beispielsweise Wirbelkörperfrakturen erleiden können. Neben dem Therapieregime „Meidung einer systemischen Kortikoidtherapie“ zur Remissionserhaltung bei CED kann der frühe Einsatz z. B. von Azathioprin wie auch Anti-TNF-alpha-Therapien nicht nur nachhaltig die Remission bei CED unterstützen, sondern bei gegebenem Zusammenhang erhöhter Zytokinprofile und Frakturrisiko einer Knochendichteminderung erfolgreich entgegenwirken. Das entsprechende therapeutische Vorgehen wird nachfolgend beschrieben.

Summary

Objective of this publication is to show the close interrelationsship between inflammatory bowel diseases (IBD) and the associated incidence of osteopenia or osteoporosis. Multiple risk factors in IBD may cause a loss of bone density and finally result in a significant increase of the fracture risk. As often young patients are affected by IBD – endangered by fractures of the vertebral body as a possible consequence – ways of prevention and therapy of osteoporosis are described.

In the following different therapeutic approaches like “avoiding a systemic cortisone therapy” to preserve remission of IBD or the early use of e. g. Azathioprine as well as of Anti-TNF-alpha-therapies are elaborated. It is shown that in cases of increased cytokine profiles and a correlated increased fracture risk the treatment recommended might even antagonize a further loss of bone density.

Schlüsselwörter

Frakturrisiko - Fehlernährung - Osteo porose - chronisch entzündliche Darmerkrankung (CED) - Morbus Crohn - Colitis ulcerosa

Keywords

Fracture risk - malnutrition - osteoporosis - Inflammatory Bowel Disease (IBD) - Crohn’s disease - ulcerative colitis

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