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Männliche Osteoporose

Male osteoporosis

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Zusammenfassung

Hintergrund

Die männliche Osteoporose zählt mit über 1 Mio. Betroffener in Deutschland nicht zu den seltenen Erkrankungen. Osteoporotische Frakturen haben bei Männern eine höhere Mortalität als bei Frauen, werden aber selten abgeklärt oder einer spezifischen Therapie zugeführt.

Fragestellung

Betrachtet werden die Epidemiologie der männlichen Osteoporose, die Versorgungssituation, pathophysiologische Aspekte auf hormoneller Ebene, Risikofaktoren, diagnostische Abklärung und therapeutische Optionen.

Material und Methode

Es erfolgen ein Überblick über die aktuelle Datenlage zur männlichen Osteoporose, Empfehlungen zur Diagnostik und eine Darstellung der Studienlage zur medikamentösen Therapie.

Ergebnisse

Bei Männern ist eine gezielte Anamnese zur Erfassung der Risikofaktoren erforderlich, da in 50–70 % der Fälle Osteoporoserisikofaktoren vorliegen. Da jeder zehnte Mann über 50 Jahre eine Wirbelfraktur erlitten hat und viele Frakturen häufig unerkannt geblieben sind, beinhaltet die radiologische Primärdiagnostik eine Bildgebung der Wirbelsäule. Zur differenzialdiagnostischen Abgrenzung ist das osteologische Labor von Bedeutung. Als Therapieoptionen stehen in Deutschland der aktive Vitamin-D-Metabolit Alfacalcidol, Alendronsäure und Risedronsäure als orale Bisphosphonate, Zoledronsäure als i.v.-Bisphosphonat, Strontiumranelat sowie als s.c.-Injektion der antiresorptiv wirksame Rank-Ligand-Antikörper Denosumab und das osteoanabol wirksame Teriparatid zur Verfügung.

Schlussfolgerungen

Die männliche Osteoporose muss als sozioökonomisch bedeutendes, abklärungs- und behandlungsbedürftiges Krankheitsbild wahrgenommen werden. Das breite Spektrum wissenschaftlich sehr gut belegter medikamentöser Behandlungsoptionen verpflichtet zu einer differenzierten, individuellen Therapie von Männern mit Osteoporose.

Abstract

Background

Osteoporosis in men is an important public health problem with more than 1 million cases in Germany. Although osteoporotic fractures have a much higher mortality in men than in women, male patients are still underdiagnosed and undertreated.

Objective

Epidemiology of male osteoporosis and current treatment situation, pathophysiological aspects at the hormonal level, risk factors, diagnostic work-up and therapeutic options.

Material and methods

Overview of data concerning male osteoporosis, recommendations for diagnostic work-up and presentation of the study situation on pharmaceutical therapies.

Results

As risk factors for osteoporosis are present in 50–70 % of male patients, a detailed patient history is necessary for assessment of the risk factors. Radiological imaging of the spine is primarily recommended to identify individuals with prevalent vertebral fractures, as approximately 10 % of males above the age of 50 years have suffered a vertebral fracture. Laboratory testing of relevant parameters helps to rule out other metabolic bone diseases. In Germany, specific medications available for the treatment of male osteoporosis comprise the active vitamin D analogue alfacalcidol, the oral bisphosphonates alendronate and risedronate, the intravenous biphosphonate zoledronic acid, the anti- receptor activator of NF-κB ligand (RANKL) antibody denosumab, which can be given as intravenous injection and strontium ranelate, a drug with a complex mode of action. Teriparatide, a recombinant form of the 34 N-terminal amino acid sequence of parathyroid hormone is the only anabolic agent approved for male osteoporosis.

Conclusion

Osteoporosis in men is increasingly being recognized as an important public health problem and affected patients need to be adequately diagnosed and treated. Nowadays, a broad spectrum of well-proven therapeutic options with different modes of action allow individual treatment strategies for male osteoporosis patients.

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Author information

Authors and Affiliations

  1. Medizinische Klinik II, Nephrologie und Nierentransplantation, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Klinikstr. 33, 35392, Gießen, Deutschland

    P. Farahmand

  2. Medizinische Klinik, Abteilung für Innere Medizin, Universitätsspital Basel, Am Petersgraben 4, 4031, Basel, Schweiz

    R. Spiegel

  3. Westdeutsches Osteoporose Zentrum, Medizinische Klinik 4, Klinikum Leverkusen, Am Gesundheitspark, Leverkusen, Deutschland

    J. D. Ringe

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  1. P. Farahmand
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  3. J. D. Ringe
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Corresponding author

Correspondence to P. Farahmand.

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Interessenkonflikt

P. Farahmand: Beratertätigkeiten für Amgen, MSD; Vortragshonorare: Amgen, Lilly, Fresenius, Novartis, Nycomed. R. Spiegel gibt an, dass kein Interessenkonflikt besteht. J.D. Ringe: Beratertätigkeiten für Amgen, Leo-Pharma, Teva, Meda, KBN, Genogyn.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Redaktion

U. Lange, Bad Nauheim

G. Schett, Erlangen

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Farahmand, P., Spiegel, R. & Ringe, J.D. Männliche Osteoporose. Z Rheumatol 75, 459–465 (2016). https://doi.org/10.1007/s00393-016-0078-2

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