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Diabetes aktuell 2018; 16(03): 112-117
DOI: 10.1055/a-0635-7959
Schwerpunkt
Osteoporose
© Georg Thieme Verlag Stuttgart · New York

Osteoporose bei Typ-1- und Typ-2-Diabetes

Einfluss des Blutzuckers auf Knochendichte und Frakturrisiko
Stephan Scharla
1   Internist und Endokrinologe/Diabetologe, Osteologe DVO, Bad Reichenhall
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Publication History

Publication Date:
26 June 2018 (online)

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ZUSAMMENFASSUNG

Diabetes mellitus und Osteoporose sind häufige Erkrankungen. Deshalb gibt es viele Patienten, die an beiden Krankheiten gleichzeitig leiden. Darüber hinaus sind jedoch sowohl der Typ-1- als auch der Typ-2-Diabetes jeweils prädisponierende Erkrankungen, die das Risiko für Osteoporose und Frakturen erhöhen. Dabei ist das Risiko bei einem Diabetes mellitus Typ 1 stärker ausgeprägt, während bei Diabetes mellitus Typ 2 vor allem Patienten mit längerer Krankheitsdauer, schlechter Stoffwechsellage, Insulinpflichtigkeit und vaskulären Folgeschäden frakturgefährdet sind. Die Knochendichte ist bei Menschen mit Typ-1-Diabetes erniedrigt, während insbesondere adipöse Typ-2-Diabetespatienten auch höhere Knochendichtewerte aufweisen können. Das Frakturrisiko wird jedoch nicht nur durch Veränderungen der Knochendichte und der Knochenarchitektur erhöht, sondern auch durch veränderte Knochenmaterialeigenschaften (veränderte Kollagen-Quervernetzung). Pathogenetische Faktoren sind Hyperglykämie, hormonelle Veränderungen und der Einfluss von oralen Antidiabetika. Während Inkretine und DPP-4-Hemmer das Frakturrisiko zu senken scheinen, sind Glitazone mit höherem Risiko assoziiert. Auch SGLT-2-Hemmer könnten bei eingeschränkter Nierenfunktion mit einem höheren Frakturrisiko behaftet sein. Die Therapie der Osteoporose bei Menschen mit Diabetes mellitus unterscheidet sich nicht vom Vorgehen bei primärer Osteoporose. Die Effizienz von antiresorptiven Medikamenten wird durch den Diabetes mellitus nicht beeinflusst.

 

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