Die Osteoporose des Mannes

Zusammenfassung

Die Therapie der männlichen Osteoporose umfasst eine eventuell notwendige Änderung des Lebensstils, eine adäquate Kalzium- und Vitamin-D-Versorgung sowie eine pharmakologische oder, bei nachgewiesenem Hypogonadismus, eine hormonelle Therapie. Ganz allgemein gilt, dass die Datenlage hinsichtlich des Kalziumbedarfs bzw. des Wirkungsgrads der antiresorptiven oder knochenanabolen Therapie bei Männern deutlich spärlicher ist als bei Frauen mit Osteoporose. Therapie der ersten Wahl sind die oralen Bisphosphonate Alendronat oder Risedronat. Kommt es bei deren Einnahme zu Unverträglichkeitsreaktionen oder liegen entsprechende Kontraindikationen vor, können auch parenterale Bisphosphonate eingesetzt werden. Bei Männern mit fortgeschrittener Osteoporose bzw. nach Frakturen unter laufender antiresorptiver Therapie besteht bei hohem Refrakturrisiko die Möglichkeit einer knochenanabolen Therapie mit Teriparatid (PTH 1–34). Hier sollte dann das Bisphosphonat abgesetzt und nach Beendigung des PTH-Therapieintervalles wieder eingeleitet werden. Liegt ein Hypogonadismus mit entsprechender Symptomatik vor, kann nach Ausschluss einer vorliegenden Kontraindikation für eine Testosterontherapie eine solche unter entsprechender Observanz erfolgen. Sind Kontraindikationen vorhanden, stellen Bisphosphonate bei diesen Patienten eine mögliche Therapiealternative dar.

Summary

Treatment of male osteoporosis comprises an adequate supply of calcium and vitamin D, a change in life-style if indicated, a pharmacological treatment or in the case of proven hypogonadism, treatment with testosterone. Data available for men with osteoporosis in terms of the optimum amount of recommended calcium intake or anti-fracture efficacy of antiresorptive or anabolic treatment is sparse compared to that for women. The treatments of choice are the oral bisphosphonates alendronate and risedronate. In case of intolerance or contraindications for oral bisphosphonates intravenous formulations may also be used. For men with advanced osteoporosis, i. e. those acquiring fractures under ongoing treatment with antiresorptives and having a high risk of refracture there is the additional option of treatment with teriparatide (PTH 1–34). Upon initiation of such anabolic treatment, bisphosphonates should be discontinued and restarted after cessation of teriparatide treatment. Men with hypogonadism and the corresponding clinical symptoms may be treated with testosterone if there are no contraindications for such a treatment and patients are willing to comply with the necessary followup investigations. In the case of contraindications, bisphosphonates are an alternative treatment option.

Schlüsselwörter

Frakturen - Glukokortikoide - Mann - Osteoporose - Hypogonadismus

Keywords

Fractures - glucocorticoids - male - osteoporosis - hypogonadism

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