Management der Osteoporose bei entzündlich-rheumatischen Erkrankungen

Zusammenfassung

Entzündlich-rheumatische Erkrankungen, wie die rheumatoide Arthritis, die ankylosierende Spondylitis, der systemische Lupus erythematodes, die systemische Sklerose und weitere entzündliche Systemerkrankungen, gehen mit einem erhöhten Risiko für die Komorbiditäten Osteoporose und osteoporotische Frakturen einher. Eine hohe entzündliche Krankheitsaktivität, Einschränkungen der Mobilität sowie der Einsatz von Glukokortikoiden sind bei diesen entzündlich-rheumatischen Erkrankungen wesentliche Risikofaktoren für einen Anstieg des Frakturrisikos neben bereits vorhandenen Frakturrisiken. Daher ist eine frühzeitige Entzündungshemmung mit dem Ziel der Remission der Krankheitsaktivität anzustreben. Eine frühzeitige Untersuchung auf eine Osteoporose sollte essentieller Bestandteil von rheumatologischen Behandlungen sein, um eine entzündungsbedingte Osteoporose frühzeitig zu erkennen und die Risiken für osteoporotische Frakturen zusätzlich durch eine spezifische Osteoporosetherapie zu senken. Die vorhandenen Leitlinien bieten ausreichend Orientierung, um dies im Rahmen der ambulanten und stationären Versorgung der betroffenen Patienten zu erreichen.

Abstract

Inflammatory rheumatic diseases such as rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, systemic sclerosis and other systemic inflammatory diseases are associated with an increased risk of comorbid osteoporosis and osteoporotic fractures. High disease activity, reduced mobility and systemic glucocorticoid treatment are significant risk factors increasing the risk of fractures additionally to the background fracture risk. Therefore an early inhibition of inflammatory activity aiming at the remission of disease activity is essential. Evaluation of disease activity in patients with rheumatic diseases should include early assessment of osteoporosis so that inflammation-induced osteoporosis can be detected early and the risk of osteoporotic fractures can additionally be reduced with specific antiosteoporotic medications. Existing guidelines offer sufficient guidance to achieve this in the outpatient and inpatient care of these patients.

Schüsselwörter

entzündlich-rheumatische Erkrankungen - Osteoporose - Frakturrisiko - Frakturprävention

Key words

inflammatory rheumatic diseases - osteoporosis - fracture risk - fracture prevention

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