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Osteologie 2019; 28(04): 268-273
DOI: 10.1055/a-0999-9781
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Osteoporose beim Idiopathischem Parkinson-Syndrom: Risikopatienten erkennen, diagnostizieren und richtig behandeln

Osteoporosis and Idiopathic Parkinson’s Disease: Identify, diagnose and treat high-risk patients
Philipp Bergmann
1   Klinik für Allgemeine Innere Medizin I, UKSH Campus Kiel, Bereich Internistische Altersmedizin
,
Kirsten Emmert
2   Klinik für Neurologie, UKSH Campus Kiel, Arbeitsgruppe Neurogeriatrie
,
Walter Maetzler
2   Klinik für Neurologie, UKSH Campus Kiel, Arbeitsgruppe Neurogeriatrie
› Author Affiliations
Further Information

Publication History

08/02/2019

08/20/2019

Publication Date:
14 November 2019 (online)

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Zusammenfassung

Patienten mit idiopathischem Parkinson-Syndrom (IPS) erkranken deutlich häufiger als die Allgemeinheit an Osteoporose. Dies kann sowohl auf Gemeinsamkeiten in der Pathogenese als auch auf die Begleiterkrankungen des IPS, von denen zahlreiche Risikofaktoren für Osteoporose darstellen, zurückgeführt werden. In diesem Artikel werden verschiedene Risikofaktoren vorgestellt, auf die in der Praxis geachtet werden sollte. Insbesondere wird auf Vitamin D-Mangel, Hyperhomocysteinämie in Zusammenhang mit Levodopa-Einnahme und Mangelernährung sowie Konsequenzen der Immobilität eingegangen. Aufgrund des erhöhten Osteoporoserisikos ist es sinnvoll, dass nach der Diagnosestellung des IPS eine Basisdiagnostik der Osteoporose erfolgt und die IPS-Patienten auch im Verlauf immer wieder auf Osteoporose untersucht werden. Obwohl der Zusammenhang von IPS und Osteoporose allgemein bekannt ist, führt die Diagnose einer Osteoporose beim IPS häufig nicht zu einer ausreichenden Therapie. Konkret kann die Osteoporose bei IPS-Patienten durch Physio- und Ergotherapie, eine Anpassung von Lebensstil (Reduzierung von Alkohol und Nikotinkonsum) und Ernährung, großzügige Supplementierung von Vitamin D und durch Gabe einer spezifischen antiosteoporotischen Medikation, wie z. B. Bisphosphonaten, behandelt werden. Eine Studie, die noch validiert werden muss, zeigt auch einen positiven Effekt einer Substitution von Folsäure und Cobalamin, um die Homocystein-Serumkonzentration zu senken. Bei der medikamentösen Behandlung ist bei IPS-Patienten auch insbesondere zu beachten, dass die orale Einnahme der Medikamente einen suffizienten Schluckakt voraussetzt. Für IPS-Patienten mit kritischer Dysphagie stehen auch parenterale Applikationsformen zur Verfügung. Aufgrund der Komplexität der Behandlung des IPS und der Osteoporose bedarf es somit eines interdisziplinären und multiprofessionellen Behandlungsteams, das Neurologen, Geriater und Ernährungsmediziner mit einschließt.

Abstract

Osteoporosis is significantly more frequent in patients with idiopathic Parkinson’s syndrome (IPS) in comparison to the general public. This can be attributed to the common pathogenesis as well as to the concomitant diseases of IPS, many of which are risk factors for osteoporosis. This article presents several risk factors that should be considered when working with IPS patients. In particular, vitamin D deficiency, hyperhomocysteinemia, in association with levodopa treatment and malnutrition as well as consequences of immobility are discussed. Due to the increased risk of osteoporosis, it is reasonable to screen for osteoporosis after IPS has been diagnosed and repeat screening throughout the IPS treatment. Although the relationship between IPS and osteoporosis is generally known, the diagnosis of osteoporosis often does not lead to adequate therapy. Osteoporosis in IPS patients can be treated by physio- and occupational therapy, an adaptation of lifestyle (reduction of alcohol and nicotine consumption), supplementation with calcium and vitamin D and, if necessary, the administration of bisphosphonates. A study that still needs to be validated also shows a positive effect of a substitution of folic acid and cobalamin to lower the homocysteine serum concentration. When treating IPS patients with medication, it should also be noted that oral administration of the medication requires a sufficient swallowing ability. For IPS patients with critical dysphagia, parenteral administration forms are also applicable. Due to the complexity of the treatment of IPS and osteoporosis, an interdisciplinary and multi-professional team including neurologists, geriatricians and nutritionists is required for adequate treatment.

Schlüsselwörter

Osteoporose - Fraktur - Idiopathisches Parkinson-Syndrom - Bisphosphonat - Vitamin D - Sturzgefahr

Key words

Osteoporosis - fracture - idiopathic Parkinson’s disease - bisphosphonate - vitamin D - danger of falling
 

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