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Osteologie 2019; 28(04): 259-267
DOI: 10.1055/a-1005-8190
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Osteoporose und Frakturen bei Multipler Sklerose – unterschätzt und ignoriert?

Osteoporosis and fracture in Multiple Sclerosis – underestimated and ignored?
Olga Zimmermann
Klinik für Neurologie, Christian-Albrechts-Universität Kiel
,
Klarissa Hanja Stürner
Klinik für Neurologie, Christian-Albrechts-Universität Kiel
› Author Affiliations
Further Information

Publication History

08/02/2019

08/30/2019

Publication Date:
14 November 2019 (online)

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Zusammenfassung

Multiple Sklerose (MS) ist eine chronisch entzündliche Autoimmunerkrankung des zentralen Nervensystems mit hoher Prävalenz. Mehrere Studien zeigen die deutlich erhöhte Häufigkeit sowohl von Frakturen als auch einer Osteoporose bei MS-Erkrankten: So besteht ein in mehreren Studien gezeigtes knapp 3-fach erhöhtes Hüftfrakturrisiko bei MS-Patienten, die Prävalenz von Osteopenie und Osteoporoserate ist bis zu 10-fach gegenüber der Normalbevölkerung erhöht. Der deutlichste Zusammenhang besteht zwischen dem Osteoporoserisiko und -ausmaß und dem Grad der Immobilität, aber auch die entzündliche Krankheitspathologie sowie Lebensstilfaktoren wie Vitamin D, Rauchen, sowie hormonelle Dysregulationen, Begleiterkrankungen und Medikamente tragen grundsätzlich und kumulativ zum erhöhten Osteoporose- und Frakturrisiko bei. Das deutlich erhöhte Osteoporose und Frakturrisiko wird im klinischen Alltag von MS-Patienten nur selten thematisiert, obwohl schon früh eine negative Beeinträchtigung des Knochenstoffwechsels vorliegt. Frakturrisiko und Osteoporose sind daher eine bisher unterschätzte Problematik bei MS-Erkrankten, die in einem präventiven Ansatz früh von den Behandlern thematisiert werden sollte. Ausgleich einer Vitamin D-Defizienz und vor allem ein Erhalt der Mobilität sind die am besten durch Daten belegten präventiven Maßnahmen zur Vermeidung einer fortschreitenden Osteoporose und zur Reduktion des Frakturrisikos.

Abstract

Multiple sclerosis (MS) is a frequent debilitating chronic inflammatory autoimmune disease of the central nervous system. Multiple studies report a significantly increased prevalence of osteoporosis and fractures in MS patients: several studies show a 3-fold increased risk of hip fractures in MS patients, the prevalence of osteopenia and osteoporosis is reported to be 10-fold increased in comparison to the general population. The most frequent correlation exists between osteoporosis and immobility. However, the inflammatory etiology as well as life style factors like Vitamin D levels, smoking as well as hormonal dysregulations, comorbidities and co-medication contribute to the increased risk of osteoporosis and fractures in MS. The early presence of osteoporosis and its high prevalence in MS is underestimated so far and should be considered in clinical routine and communicated to patients. Due to the importance of preventive strategies, patients and physicians should more often be aware of the high prevalence of osteoporosis in MS. The most important preventive strategies for osteoporosis and fracture risk are physical activity (or better sports) and substitution of insufficient Vitamin D serum levels.

Schlüsselwörter

Multiple Sklerose - Osteoporose - Frakturen - Vitamin D

Key words

Multiple sclerosis - osteoporosis - fractures - vitamin D
 

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