Nicht-medikamentöse Maßnahmen

Zusammenfassung

Zu den Faktoren, die neben der erblichen Veranlagung den größten Einfluss auf die „peak bone mass” ausüben, zählen eine angemessene Kalorienaufnahme und ausreichendes Körpergewicht, der Einfluss der Sexualhormone während der Pubertät sowie körperliche Aktivität. Zusätzlich kann eine Supplementation von Kalzium und Vitamin D erforderlich werden. Kalzium ist der wichtigste Nahrungsbestandteil zum Erreichen der „peak bone mass” sowie zur Prävention und Behandlung der Osteoporose. Für eine optimale Kalziumaufnahme im Darm ist Vitamin D erforderlich. Die Vitamin D-Insuffizienz kann über eine Beeinträchtigung der Körperschwankung und der neuromuskulären Koordination das Risiko von Schenkelhalsfrakturen erhöhen. Körperliche Aktivität beim Heranwachsenden trägt zu einer höheren „peak bone mass” bei. Bei gebrechlichen Individuen erhöht körperliches Training Muskelmasse und -kraft. Externe Hüftprotektoren vermindern durch eine Absorption der Energie während eines Sturzes die Inzidenz von Schenkelhalsfrakturen. Bei Patienten mit vertebraler Osteoporose können spezielle Orthesen für die Wirbelsäule zu einer Verbesserung der Parameter der Lebensqualität wie zum Beispiel Schmerz, Wohlbefinden und Limitationen im täglichen Leben führen. Die Aufklärung und Schulung der Patienten besitzt im „Disease Management” der Osteoporose eine erhebliche Bedeutung. Die Kenntnis der Risikofaktoren für eine Osteoporose verbessert Prävention und Therapie und vermindert das Auftreten von Frakturen. Bei älteren Frauen mit bereits vorhandenen Wirbelkörperfrakturen führen Rückengymnastik, Schmerzbewältigung und psychosoziale Beratung zu einer Kräftigung der Rückenmuskulatur mit geringeren Alltagseinschränkungen und belastbarer Psyche. Im Kindes- und Jugendalter können Kalziumaufnahme, körperliche Aktivität und Muskelkraft durch Schulungsprogramme gesteigert werden. Die Meta-Analysen klinischer Studien zur Wirksamkeit von körperlichen Bewegungsübungen und Trainingsprogrammen in Prävention und Behandlung der Osteoporose werden allerdings durch eine große Heterogenität der Studien erschwert.

Non-Drug Treatment Methods

Among the factors exercising the greatest influence on “peak bone mass” besides hereditary traits are an adequate intake of calories and sufficient body weight, the influence of the sexual hormones during puberty, as well as physical activity. It may also be necessary to provide for an adequate supply of calcium and vitamin D. Calcium is the most important nutritional component for attaining the “peak bone mass” and in the prevention and treatment of osteoporosis. Vitamin D is mandatory for ensuring optimal intestinal calcium intake. Vitamin D insufficiency may enhance the risk of femoral neck fractures via a negative effect on the stability of body posture and on neuromuscular coordination. Adolescent physical activity contributes towards a higher “peak bone mass”. Physical training enhances muscle mass and muscle power of persons whose mobility is impaired. External hip protectors reduce the incidence of femoral neck fractures by absorbing the energy expended while falling. In patients suffering from vertebral osteoporosis, special ortheses for the spine may improve parameters of life quality such as pain, thus making everyday life easier. Instructing and training the patients is a most important feature of disease management. Knowing the risk factors of osteoporosis improves prevention and treatment and reduces the incidence of fractures. In elderly women already suffering from vertebral fractures, the muscles of the back may be strengthened by gymnastics of the back, which in addition to mental pain control and psychosocial counselling will reduce everyday handicaps and improve the ability to overcome mental stress. In children and adolescents it is possible to increase calcium intake, physical activity and muscle power by means of school training programmes. However, the extensive heterogeneity of the relevant studies stands to some extent in the way of their meta-analysis in respect of the effectivity of physical mobility exercises and of training programmes for the prevention and treatment of osteoporosis.

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