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Stadieneinteilung der CKD anhand GFR und Albuminurie (not graded).<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Osteoporose: Erkrankung des Skeletts (verminderte Knochenmasse, St\u00f6rung der Mikroarchitektur) mit erh\u00f6htem Knochenbruchrisiko. Bei einem T\u2011Score\u202f\u2264\u2009\u22122,5 liegt definitionsgem\u00e4\u00df eine Osteoporose vor. Bei Auftreten einer Fraktur nach inad\u00e4quatem Trauma liegt, unabh\u00e4ngig vom T\u2011Score, eine manifeste Osteoporose vor (not graded).<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Die Pr\u00e4valenz von Osteoporose und osteoporotischen Frakturen sowie die CKD nehmen weltweit zu (not graded).<\/jats:p>\n                  <\/jats:list-item>\n                <\/jats:list><\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Pathophysiologie, Diagnostik und Therapie der Chronic Kidney Disease\u00a0\u2013 Mineral and Bone Disorder (CKD-MBD)<\/jats:title>\n                <jats:p><jats:list list-type=\"bullet\">\n                  <jats:list-item>\n                    <jats:p>Definition des CKD-MBD-Syndroms: St\u00f6rung des Kalzium\u2011, Phosphat\u2011, Vitamin-D- und Parathormon(PTH)-Haushalts sowie renale Osteodystrophie und vaskul\u00e4re Kalzifikation (not graded).<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Knochenstoffwechsel bei renaler Osteodystrophie: gesteigerter, normaler oder verminderter Knochenumbau m\u00f6glich (not graded).<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Regelm\u00e4\u00dfige Laborkontrollen von Kalzium, Phosphat, alkalischer Phosphatase, PTH und 25-OH-Vitamin\u00a0D mit Kontrollintervall je nach CKD-Stadium werden empfohlen (2C).<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Therapieziele bei CKD-MBD:<jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Hyperkalz\u00e4mie vermeiden (1C)<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Erh\u00f6htes Phosphat in Richtung Normalbereich senken (2C)<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>PTH im Normbereich bis leicht erh\u00f6ht halten (2D)<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Vitamin-D-Mangel vermeiden bzw. beheben (1C)<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list><\/jats:p>\n                  <\/jats:list-item>\n                <\/jats:list><\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Diagnostik und Risikostratifizierung der Osteoporose bei CKD<\/jats:title>\n                <jats:p><jats:list list-type=\"bullet\">\n                  <jats:list-item>\n                    <jats:p>Densitometrie (mittels Dual Energy X\u2011ray Absorptiometry [DXA]): Niedriger T\u2011Score korreliert in allen Stadien der CKD mit h\u00f6herem Frakturrisiko (not graded).<jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Verdopplung des Frakturrisikos pro Abnahme des T\u2011Scores um 1\u00a0Einheit (not graded).<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>T\u2011Score\u202f&gt;\u2009\u22122,5 schlie\u00dft eine Osteoporose nicht aus (not graded).<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Falsch-hohe LWS-KMD-Messergebnisse k\u00f6nnen unter anderem bei aortaler Verkalkung, degenerativen Wirbels\u00e4ulenver\u00e4nderungen (Osteophyten) oder bei bereits eingebrochenen Wirbelk\u00f6rpern vorkommen (not graded).<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list><\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>FRAX: Anwendung in allen CKD-Stadien orientierend m\u00f6glich (1C).<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Knochenstoffwechselmarker: Bestimmung in Einzelf\u00e4llen zum Therapiemonitoring (2D).<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Knochenbiopsie: In Einzelf\u00e4llen, insbesondere bei CKD G5 (eGFR\u202f&lt;\u200915\u202fml\/min\/1,73\u202fm<jats:sup>2<\/jats:sup>) und CKD G5D (Dialyse) erw\u00e4gen (2D).<\/jats:p>\n                  <\/jats:list-item>\n                <\/jats:list><\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Spezifische Therapie der Osteoporose bei CKD<\/jats:title>\n                <jats:p><jats:list list-type=\"bullet\">\n                  <jats:list-item>\n                    <jats:p>Hypokalzi\u00e4mie vor Einleitung einer spezifischen Osteoporosetherapie ausgleichen (1C)<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Bei CKD G1\u2013G2 (eGFR\u202f\u2265\u200960\u202fml\/min\/1,73\u202fm<jats:sup>2<\/jats:sup>): Behandlung der Osteoporose wie f\u00fcr die Allgemeinbev\u00f6lkerung empfohlen (1A).<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Bei CKD G3\u2013G5D (eGFR\u202f&lt;\u200960\u202fml\/min\/1,73\u202fm<jats:sup>2<\/jats:sup> bis Dialysestadium): prim\u00e4r Behandlung der laborchemischen Zeichen einer CKD-MBD (2C).<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Bei CKD G3 (eGFR 30\u201359\u202fml\/min\/1,73\u202fm<jats:sup>2<\/jats:sup>) mit PTH im Normbereich und osteoporotischer Fraktur und\/oder hohem Frakturrisiko gem\u00e4\u00df FRAX: Behandlung der Osteoporose wie f\u00fcr die Allgemeinbev\u00f6lkerung empfohlen (2B).<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Bei CKD G4\u20135 (eGFR\u202f&lt;\u200930\u202fml\/min\/1,73\u202fm<jats:sup>2<\/jats:sup>) und osteoporotischer Fraktur (Sekund\u00e4rpr\u00e4vention): Osteoporosetherapie individualisiert empfohlen (2C).<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Bei CKD G4\u20135 (eGFR\u202f&lt;\u200930\u202fml\/min\/1,73\u202fm<jats:sup>2<\/jats:sup>) mit hohem Frakturrisiko (z.\u202fB. FRAX-score\u202f&gt;\u200920\u202f% f\u00fcr eine \u201emajor osteoporotic fracture\u201c oder\u202f&gt;\u20095\u202f% f\u00fcr eine H\u00fcftfraktur) ohne osteoporotische Fraktur (Prim\u00e4rpr\u00e4vention): Osteoporosetherapie erw\u00e4gen und ggf. auch einleiten (2D).<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Antiresorptive Behandlung bei CKD G4\u20135 (eGFR\u202f&lt;\u200930\u202fml\/min\/1,73\u202fm<jats:sup>2<\/jats:sup>): Kalziumkontrolle 1 bis 2\u00a0Wochen nach Therapiebeginn (1C).<\/jats:p>\n                  <\/jats:list-item>\n                <\/jats:list><\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Physikalisch-rehabilitative Ma\u00dfnahmen<\/jats:title>\n                <jats:p><jats:list list-type=\"bullet\">\n                  <jats:list-item>\n                    <jats:p>Krafttraining gro\u00dfer Muskelgruppen dreimal w\u00f6chentlich (1B).<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Ausdauertraining viermal w\u00f6chentlich 40\u202fmin (1B).<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Koordinationstraining\/Balance\u00fcbungen dreimal w\u00f6chentlich (1B).<\/jats:p>\n                  <\/jats:list-item>\n                  <jats:list-item>\n                    <jats:p>Beweglichkeits\u00fcbungen drei- bis siebenmal w\u00f6chentlich (1B).<\/jats:p>\n                  <\/jats:list-item>\n                <\/jats:list><\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s10354-022-00989-0","type":"journal-article","created":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T07:02:37Z","timestamp":1671606157000},"page":"299-318","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Diagnose und Therapie der Osteoporose bei Patienten mit chronischer Niereninsuffizienz","Diagnosis and treatment of osteoporosis in patients with chronic kidney disease"],"prefix":"10.1007","volume":"173","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7162-1443","authenticated-orcid":false,"given":"Daniel","family":"Cejka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Wakolbinger-Habel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuel","family":"Zitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"Fahrleitner-Pammer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Amrein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans Peter","family":"Dimai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Muschitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,12,21]]},"reference":[{"issue":"1","key":"989_CR1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1038\/kisup.2012.64","volume":"3","author":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group","year":"2013","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. 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