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Osteologie 2018; 27(01): 14-19
DOI: 10.1055/s-0038-1636973
Therapieinduzierte Osteoporose – Treatment-induced osteoporosis
Schattauer GmbH

Osteoporose bei hormonablativer Therapie

Osteoporosis in patients with hormonal ablative therapy
F. Thomasius
1   Osteologisches Schwerpunktzentrum DVO und Osteooonkologische Sprechstunde am Krankenhaus Nordwest, Frankfurt
,
P. Hadji
2   Klinik für Gynäkologie und Geburtshilfe, Sektion Osteoonkologie, Gyn. Endokrinologie und Reproduktionsmedizin, Krankenhaus Nordwest, Frankfurt a.M., Philips-Universität Marburg
› Author Affiliations
Further Information

Publication History

eingereicht: 09 November 2017

angenommen: 29 November 2017

Publication Date:
07 March 2018 (online)

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Zusammenfassung

Die hormonablative Therapie bei Patientinnen mit Brustkrebs und Patienten mit Prostatakarzinom ist mit einem erhöhten Knochenmassenverlust und konsekutiv erhöhtem Osteoporose- und somit Frakturrisiko verbunden. Der therapeutisch erwünschte Eintritt einer verfrühten Menopause führt bei Patientinnen mit Brustkrebs zu substanziellen Knochenmassen- und Strukturverlusten als Folge des iatrogen erniedrigten Östrogenspiegels, postmenopausal ist die hormonablative Therapie Ursache einer erhöhten Knochenresorption. Die hormonablative Therapie bei Patienten mit hormonsensitivem Prostatakarzinom führt zu verminderten Östrogen- und Testosteronspiegeln und einem hierdurch beschleunigt stattfindenden Knochenmassenverlust. In allen genannten hormonablativen Situationen übersteigt der durch den Hormonentzug ausgelöste Knochenmassenverlust den altersbedingt zu erwartenden Knochenmassenverlust deutlich. Entsprechend steigt das Frakturrisiko deutlicher und im Vergleich zu Formen der primären Osteoporose nahezu exponentiell an. Diese Abkopplung des Frakturrisikos von den gemessenen Knochendichtewerten und -veränderungen passt zu dem Bild einer sekundären Osteoporose. Präventive Maßnahmen zum Erhalt der Knochengesundheit sind aus diesem Grunde obligat, spezifische Therapien zur Verhinderung des zu erwartenden Knochenmassenverlustes sind früher als bei der primären Osteoporose aus osteologischer Sicht indiziert. Hierfür benötigt es klar definierte Therapieschwellenwerte.

Summary

The hormonal ablative therapy in patients with hormonal sensitive breast or prostate cancer leads to an accelerated loss of bone mass, bone architecture and consecutive increase in fracture risk. Estrogen and androgen deprivation therapy is associated with an increased risk of osteoporosis. Premature menopause in premenopausal women as consequence of cancer treatment, the extremely low levels of circulating estrogen in postmenopausal women and the total androgen deprivation and also reduced levels of circulating estrogen in men lead to an enhanced cancer treatment induced negative effect on bone metabolism. Hereby, chemotherapy alone has been shown to have an additional negative effect on bone metabolism. Therefore fracture risk is far more increased in patients with hormonal ablative therapy in comparison to patients with primary osteoporosis. This could be interpreted as a state of secondary osteoporosis e.g. seen in patients with corticosteroid induced osteoporosis. It is therefore mandatory to screen patients undergoing hormobalative therapy ideally prior to chemotherapy and/or adjuvant GnRH and Aromatase Inhibitor treatment (AI) or Androgen-Deprevation- Therapy (ADT) to assess fracture risk and to guide these patients with regard to bone loss preventive measures. For patients with increased fracture risk, clearly defined treatment thresholds need to be identified and implemented.

Schlüsselwörter

Hormonablation - Knochenmassenverlust - Frakturrisiko - Osteoporose

Keywords

Hormonal ablation - bone loss - fracture risk - osteoporosis
 

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