Osteologie 2019; 28(04): 246-251
DOI: 10.1055/a-0999-9866
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Depression, Osteoporose, Stürze und Frakturen

Depression, osteoporosis, falls and fractures
Kilian Rapp
Klinik für Geriatrische Rehabilitation und Abteilung für Geriatrie, Robert-Bosch-Krankenhaus
,
Klaus Pfeiffer
Klinik für Geriatrische Rehabilitation und Abteilung für Geriatrie, Robert-Bosch-Krankenhaus
› Author Affiliations
Further Information

Publication History

08/02/2019

08/20/2019

Publication Date:
14 November 2019 (online)

Zusammenfassung

Die Depression geht mit einem erhöhten Frakturrisiko einher. Da Fragilitätsfrakturen meist Folge eines Sturzes und/oder einer erhöhten Knochenbrüchigkeit sind, beschreibt die Übersichtsarbeit, über welche Wege die Depression Sturzrisiko und Knochendichte beeinflussen kann.

Patienten mit Depression haben ein um 50 % erhöhtes Sturzrisiko. Diskutierte Gründe sind körperliche Inaktivität, Verlust der Muskelmasse und mit einer Depression einhergehende und mit Stürzen assoziierte Gangstörungen. Zudem erhöhen Antidepressiva das Sturzrisiko um ca. 70 %.

Bei Patienten mit Depression findet sich auch eine verminderte Knochendichte. Faktoren wie körperliche Inaktivität, geringe Sonnenlichtexposition, Rauchen, Alkoholkonsum und Untergewicht, von denen bekannt ist, dass sie einen negativen Einfluss auf die Knochendichte haben, sind bei depressiven Personen häufiger anzutreffen. Zudem haben die bei Depression beobachtete erhöhte sympathische Aktivität, pro-inflammatorische Zytokine und erhöhte Serumkortisonwerte einen potentiell schädigenden Effekt auf den Knochen. Ein direkt schädigender Effekt auf den Knochen wird für die Substanzklasse der SSRIs diskutiert.

Die Beziehung zwischen Depression und Fraktur ist nicht unidirektional. Stürze und Frakturen können ihrerseits zu Sturzangst und Depression führen.

Therapeutisch hat körperliches Training einen moderaten Effekt auf die depressive Symptomatik. Für spezifische Sturzpräventionsprogramme konnte dies bisher nicht nachgewiesen werden. Kognitiv-behaviorale Ansätze stehen zur Therapie der Sturzangst zur Verfügung. Der Einsatz von Antidepressiva sollte auf mittelschwere und schwere Depressionen beschränkt werden. Der Beginn sollte mit niedrigen Dosen erfolgen, Blutdruck und Elektrolyte müssen kontrolliert werden. Trizyklische Antidepressiva sollten bei älteren Patienten ganz vermieden werden.

Depression/Antidepressiva finden als Risikofaktoren in den DVO-Leitlinien Berücksichtigung.

Abstract

Depression is associated with an increased fracture risk. Most fragility fractures are caused by a fall and/or a low bone mass density (BMD). Therefore, this overview describes pathways by which depression may influence fall risk and BMD.

Fall risk is increased by 50 % in patients with depression. Physical inactivity, loss of muscle mass, and with depression and falls associated gait disorders may contribute to the observed fall risk. Furthermore, antidepressants increase fall risk by about 70 %.

Depression is also associated with lower BMD. Established risk factors for osteoporosis like physical inactivity, low sun exposure, smoking, alcohol consumption are observed more frequently in people with depression. In addition, an increased sympathetic nervous system activity, pro-inflammatory markers and hypercortisolism are associated with depression. SSRIs may have also deleterious effects on bone.

The relation between depression and fractures is not unidirectional. Falls and fractures can be also the reason for fear of falling and depression.

As treatment physical training has only a moderate effect on depressive symptoms. This has not been shown for specific fall prevention programs. Cognitive-behavioral approaches are an option in people with an excessive fear of falling. The use of antidepressants should be limited to moderate and severe depression. Starting dose should be low, blood pressure and electrolytes should be monitored. Tricyclic antidepressants should be avoided in older patients.

Depression/antidepressants as risk factors are considered in the German osteoporosis guidelines which influence thresholds for screening and therapy.

 
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