Skip to main content
Erschienen in: Archives of Osteoporosis 1/2018

01.12.2018 | Original Article

Risk of fractures at different anatomic sites in patients with irritable bowel syndrome: a nationwide population-based cohort study

verfasst von: Herng-Sheng Lee, Chi-Yi Chen, Wan-Ting Huang, Li-Jen Chang, Solomon Chih-Cheng Chen, Hsin-Yi Yang

Erschienen in: Archives of Osteoporosis | Ausgabe 1/2018

Einloggen, um Zugang zu erhalten

Abstract

Summary

This study was to investigate the fracture risk of irritable bowel syndrome (IBS) in comparison with non-IBS group. Our results found that IBS group has increased risk for fracture, in particular of the spine, forearm, hip, and hand.

Introduction

Patients with IBS might also be at increased risk of osteoporosis and osteoporotic fractures. Up to now, the association between IBS and the risk of fractures at different anatomic sites occurrences is not completely clear. We conducted a population-based cohort analysis to investigate the fracture risk of IBS in comparison with non-IBS group.

Methods

We identified 29,505 adults aged ≥ 20 years with newly diagnosed IBS using the Taiwan National Health Insurance Research Database in 2000–2012. A comparison group was constructed of patients without IBS who were matched according to gender and age. The occurrence of fracture was monitored until the end of 2013. We analyzed the risk of fracture events to occur in IBS by using Cox proportional hazards regression models.

Results

Patients with IBS had a higher incidence of osteoporotic fractures compared with the non-IBS group (12.34 versus 9.45 per 1000 person-years) and an increased risk of osteoporotic fractures (adjusted hazard ratio [aHR] = 1.27, 95% confidence interval [CI] = 1.20–1.35). Site-specific analysis showed that the IBS group had a higher risk of fractures for spine, forearm, hip, and hand than did the non-IBS group. With further stratification for gender and age, a higher aHR value for osteoporotic fractures in the IBS group was seen across all age groups in males, but seen in elderly females. In addition, female, elderly, low income, hypertension, coronary artery disease, cerebrovascular disease, and depressive disorders as independent osteoporotic fracture risk factors in IBS patients.

Conclusions

The IBS is considered as a risk factor for osteoporotic fractures, particularly in female individuals and fracture sites located at the spine, forearm, hip, and hand.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733CrossRef Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733CrossRef
2.
Zurück zum Zitat Pisani P, Renna MD, Conversano F, Casciaro E, Di Paola M, Quarta E, Muratore M, Casciaro S (2016) Major osteoporotic fragility fractures: risk factor updates and societal impact. World J Orthop 7:171–181CrossRef Pisani P, Renna MD, Conversano F, Casciaro E, Di Paola M, Quarta E, Muratore M, Casciaro S (2016) Major osteoporotic fragility fractures: risk factor updates and societal impact. World J Orthop 7:171–181CrossRef
3.
Zurück zum Zitat Briot K, Roux C (2015) Glucocorticoid-induced osteoporosis. RMD Open 1:e000014CrossRef Briot K, Roux C (2015) Glucocorticoid-induced osteoporosis. RMD Open 1:e000014CrossRef
4.
Zurück zum Zitat Sealand R, Razavi C, Adler RA (2013) Diabetes mellitus and osteoporosis. Curr Diab Rep 13:411–418CrossRef Sealand R, Razavi C, Adler RA (2013) Diabetes mellitus and osteoporosis. Curr Diab Rep 13:411–418CrossRef
5.
Zurück zum Zitat Heidari B, Hassanjani Roushan MR (2012) Rheumatoid arthritis and osteoporosis. Caspian J Int Med 3:445–446 Heidari B, Hassanjani Roushan MR (2012) Rheumatoid arthritis and osteoporosis. Caspian J Int Med 3:445–446
6.
Zurück zum Zitat Handzlik-Orlik G, Holecki M, Wilczynski K, Dulawa J (2016) Osteoporosis in liver disease: pathogenesis and management. Ther Adv Endocrinol Metab 7:128–135CrossRef Handzlik-Orlik G, Holecki M, Wilczynski K, Dulawa J (2016) Osteoporosis in liver disease: pathogenesis and management. Ther Adv Endocrinol Metab 7:128–135CrossRef
7.
Zurück zum Zitat Krela-Kazmierczak I, Szymczak A, Lykowska-Szuber L, Eder P, Linke K (2016) Osteoporosis in gastrointestinal diseases. Adv Clin Exp Med 25:185–190CrossRef Krela-Kazmierczak I, Szymczak A, Lykowska-Szuber L, Eder P, Linke K (2016) Osteoporosis in gastrointestinal diseases. Adv Clin Exp Med 25:185–190CrossRef
8.
Zurück zum Zitat Irwin R, Raehtz S, Parameswaran N, McCabe LR (2016) Intestinal inflammation without weight loss decreases bone density and growth. Am J Phys Regul Integr Comp Phys 311:R1149–r1157 Irwin R, Raehtz S, Parameswaran N, McCabe LR (2016) Intestinal inflammation without weight loss decreases bone density and growth. Am J Phys Regul Integr Comp Phys 311:R1149–r1157
9.
Zurück zum Zitat Ali T, Lam D, Bronze MS, Humphrey MB (2009) Osteoporosis in inflammatory bowel disease. Am J Med 122:599–604CrossRef Ali T, Lam D, Bronze MS, Humphrey MB (2009) Osteoporosis in inflammatory bowel disease. Am J Med 122:599–604CrossRef
10.
Zurück zum Zitat Tilg H, Moschen AR, Kaser A, Pines A, Dotan I (2008) Gut, inflammation and osteoporosis: basic and clinical concepts. Gut 57:684–694CrossRef Tilg H, Moschen AR, Kaser A, Pines A, Dotan I (2008) Gut, inflammation and osteoporosis: basic and clinical concepts. Gut 57:684–694CrossRef
11.
Zurück zum Zitat Wada Y, Hisamatsu T, Naganuma M, Matsuoka K, Okamoto S, Inoue N, Yajima T, Kouyama K, Iwao Y, Ogata H, Hibi T, Abe T, Kanai T (2015) Risk factors for decreased bone mineral density in inflammatory bowel disease: a cross-sectional study. Clin Nutr (Edinb, Scotl) 34:1202–1209CrossRef Wada Y, Hisamatsu T, Naganuma M, Matsuoka K, Okamoto S, Inoue N, Yajima T, Kouyama K, Iwao Y, Ogata H, Hibi T, Abe T, Kanai T (2015) Risk factors for decreased bone mineral density in inflammatory bowel disease: a cross-sectional study. Clin Nutr (Edinb, Scotl) 34:1202–1209CrossRef
12.
Zurück zum Zitat Abdul Rani R, Raja Ali RA, Lee YY (2016) Irritable bowel syndrome and inflammatory bowel disease overlap syndrome: pieces of the puzzle are falling into place. Intest Res 14:297–304CrossRef Abdul Rani R, Raja Ali RA, Lee YY (2016) Irritable bowel syndrome and inflammatory bowel disease overlap syndrome: pieces of the puzzle are falling into place. Intest Res 14:297–304CrossRef
13.
Zurück zum Zitat Lu CL, Chen CY, Lang HC, Luo JC, Wang SS, Chang FY, Lee SD (2003) Current patterns of irritable bowel syndrome in Taiwan: the Rome II questionnaire on a Chinese population. Aliment Pharmacol Ther 18:1159–1169CrossRef Lu CL, Chen CY, Lang HC, Luo JC, Wang SS, Chang FY, Lee SD (2003) Current patterns of irritable bowel syndrome in Taiwan: the Rome II questionnaire on a Chinese population. Aliment Pharmacol Ther 18:1159–1169CrossRef
14.
Zurück zum Zitat Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006) Functional bowel disorders. Gastroenterology 130:1480–1491CrossRef Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006) Functional bowel disorders. Gastroenterology 130:1480–1491CrossRef
15.
Zurück zum Zitat Theodorou V, Ait Belgnaoui A, Agostini S, Eutamene H (2014) Effect of commensals and probiotics on visceral sensitivity and pain in irritable bowel syndrome. Gut Microbes 5:430–436CrossRef Theodorou V, Ait Belgnaoui A, Agostini S, Eutamene H (2014) Effect of commensals and probiotics on visceral sensitivity and pain in irritable bowel syndrome. Gut Microbes 5:430–436CrossRef
16.
Zurück zum Zitat Stobaugh DJ, Deepak P, Ehrenpreis ED (2013) Increased risk of osteoporosis-related fractures in patients with irritable bowel syndrome. Osteoporos Int 24:1169–1175CrossRef Stobaugh DJ, Deepak P, Ehrenpreis ED (2013) Increased risk of osteoporosis-related fractures in patients with irritable bowel syndrome. Osteoporos Int 24:1169–1175CrossRef
17.
Zurück zum Zitat Yen CM, Muo CH, Lin MC, Chang SN, Chang YJ, Kao CH (2014) A nationwide population cohort study: irritable bowel syndrome is a risk factor of osteoporosis. Eur J Intern Med 25:87–91CrossRef Yen CM, Muo CH, Lin MC, Chang SN, Chang YJ, Kao CH (2014) A nationwide population cohort study: irritable bowel syndrome is a risk factor of osteoporosis. Eur J Intern Med 25:87–91CrossRef
18.
Zurück zum Zitat Carroccio A, Soresi M, D'Alcamo A et al (2014) Risk of low bone mineral density and low body mass index in patients with non-celiac wheat-sensitivity: a prospective observation study. BMC Med 12:230CrossRef Carroccio A, Soresi M, D'Alcamo A et al (2014) Risk of low bone mineral density and low body mass index in patients with non-celiac wheat-sensitivity: a prospective observation study. BMC Med 12:230CrossRef
19.
Zurück zum Zitat Norgaard M, Farkas DK, Pedersen L, Erichsen R, de la Cour ZD, Gregersen H, Sorensen HT (2011) Irritable bowel syndrome and risk of colorectal cancer: a Danish nationwide cohort study. Br J Cancer 104:1202–1206CrossRef Norgaard M, Farkas DK, Pedersen L, Erichsen R, de la Cour ZD, Gregersen H, Sorensen HT (2011) Irritable bowel syndrome and risk of colorectal cancer: a Danish nationwide cohort study. Br J Cancer 104:1202–1206CrossRef
20.
Zurück zum Zitat Hsiao CW, Huang WY, Ke TW, Muo CH, Chen WT, Sung FC, Kao CH (2014) Association between irritable bowel syndrome and colorectal cancer: a nationwide population-based study. Eur J Intern Med 25:82–86CrossRef Hsiao CW, Huang WY, Ke TW, Muo CH, Chen WT, Sung FC, Kao CH (2014) Association between irritable bowel syndrome and colorectal cancer: a nationwide population-based study. Eur J Intern Med 25:82–86CrossRef
21.
Zurück zum Zitat Lai SW, Liao KF, Lin CL, Sung FC (2014) Irritable bowel syndrome correlates with increased risk of Parkinson’s disease in Taiwan. Eur J Epidemiol 29:57–62CrossRef Lai SW, Liao KF, Lin CL, Sung FC (2014) Irritable bowel syndrome correlates with increased risk of Parkinson’s disease in Taiwan. Eur J Epidemiol 29:57–62CrossRef
22.
Zurück zum Zitat Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739CrossRef Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739CrossRef
23.
Zurück zum Zitat Kanis JA, Hans D, Cooper C et al (2011) Interpretation and use of FRAX in clinical practice. Osteoporos Int 22:2395–2411CrossRef Kanis JA, Hans D, Cooper C et al (2011) Interpretation and use of FRAX in clinical practice. Osteoporos Int 22:2395–2411CrossRef
24.
Zurück zum Zitat Lai SW, Liao KF, Lai HC, Tsai PY, Lin CL, Chen PC, Sung FC (2013) Risk of major osteoporotic fracture after cardiovascular disease: a population-based cohort study in Taiwan. J Epidemiol 23:109–114CrossRef Lai SW, Liao KF, Lai HC, Tsai PY, Lin CL, Chen PC, Sung FC (2013) Risk of major osteoporotic fracture after cardiovascular disease: a population-based cohort study in Taiwan. J Epidemiol 23:109–114CrossRef
25.
Zurück zum Zitat Dinan TG, Quigley EM, Ahmed SM, Scully P, O'Brien S, O'Mahony L, O'Mahony S, Shanahan F, Keeling PW (2006) Hypothalamic-pituitary-gut axis dysregulation in irritable bowel syndrome: plasma cytokines as a potential biomarker? Gastroenterology 130:304–311CrossRef Dinan TG, Quigley EM, Ahmed SM, Scully P, O'Brien S, O'Mahony L, O'Mahony S, Shanahan F, Keeling PW (2006) Hypothalamic-pituitary-gut axis dysregulation in irritable bowel syndrome: plasma cytokines as a potential biomarker? Gastroenterology 130:304–311CrossRef
26.
Zurück zum Zitat Dinan TG, Clarke G, Quigley EM, Scott LV, Shanahan F, Cryan J, Cooney J, Keeling PW (2008) Enhanced cholinergic-mediated increase in the pro-inflammatory cytokine IL-6 in irritable bowel syndrome: role of muscarinic receptors. Am J Gastroenterol 103:2570–2576CrossRef Dinan TG, Clarke G, Quigley EM, Scott LV, Shanahan F, Cryan J, Cooney J, Keeling PW (2008) Enhanced cholinergic-mediated increase in the pro-inflammatory cytokine IL-6 in irritable bowel syndrome: role of muscarinic receptors. Am J Gastroenterol 103:2570–2576CrossRef
27.
Zurück zum Zitat Katz S, Weinerman S (2010) Osteoporosis and gastrointestinal disease. Gastroenterol Hepatol (NY) 6:506–517 Katz S, Weinerman S (2010) Osteoporosis and gastrointestinal disease. Gastroenterol Hepatol (NY) 6:506–517
28.
Zurück zum Zitat Khayyat Y, Attar S (2015) Vitamin D deficiency in patients with irritable bowel syndrome: does it exist? Oman Med J 30:115–118CrossRef Khayyat Y, Attar S (2015) Vitamin D deficiency in patients with irritable bowel syndrome: does it exist? Oman Med J 30:115–118CrossRef
30.
Zurück zum Zitat Cozma-Petrut A, Loghin F, Miere D, Dumitrascu DL (2017) Diet in irritable bowel syndrome: what to recommend, not what to forbid to patients! World J Gastroenterol 23:3771–3783CrossRef Cozma-Petrut A, Loghin F, Miere D, Dumitrascu DL (2017) Diet in irritable bowel syndrome: what to recommend, not what to forbid to patients! World J Gastroenterol 23:3771–3783CrossRef
31.
Zurück zum Zitat McKenzie YA, Bowyer RK, Leach H et al (2016) British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet 29:549–575CrossRef McKenzie YA, Bowyer RK, Leach H et al (2016) British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet 29:549–575CrossRef
32.
Zurück zum Zitat Warden SJ, Robling AG, Haney EM, Turner CH, Bliziotes MM (2010) The emerging role of serotonin (5-hydroxytryptamine) in the skeleton and its mediation of the skeletal effects of low-density lipoprotein receptor-related protein 5 (LRP5). Bone 46:4–12CrossRef Warden SJ, Robling AG, Haney EM, Turner CH, Bliziotes MM (2010) The emerging role of serotonin (5-hydroxytryptamine) in the skeleton and its mediation of the skeletal effects of low-density lipoprotein receptor-related protein 5 (LRP5). Bone 46:4–12CrossRef
33.
Zurück zum Zitat Yadav VK, Ryu JH, Suda N, Tanaka KF, Gingrich JA, Schütz G, Glorieux FH, Chiang CY, Zajac JD, Insogna KL, Mann JJ, Hen R, Ducy P, Karsenty G (2008) Lrp5 controls bone formation by inhibiting serotonin synthesis in the duodenum. Cell 135:825–837CrossRef Yadav VK, Ryu JH, Suda N, Tanaka KF, Gingrich JA, Schütz G, Glorieux FH, Chiang CY, Zajac JD, Insogna KL, Mann JJ, Hen R, Ducy P, Karsenty G (2008) Lrp5 controls bone formation by inhibiting serotonin synthesis in the duodenum. Cell 135:825–837CrossRef
34.
Zurück zum Zitat Fernandes BS, Hodge JM, Pasco JA, Berk M, Williams LJ (2016) Effects of depression and serotonergic antidepressants on bone: mechanisms and implications for the treatment of depression. Drugs Aging 33:21–25CrossRef Fernandes BS, Hodge JM, Pasco JA, Berk M, Williams LJ (2016) Effects of depression and serotonergic antidepressants on bone: mechanisms and implications for the treatment of depression. Drugs Aging 33:21–25CrossRef
35.
Zurück zum Zitat Sikander A, Rana SV, Prasad KK (2009) Role of serotonin in gastrointestinal motility and irritable bowel syndrome. Clin Chim Acta 403:47–55CrossRef Sikander A, Rana SV, Prasad KK (2009) Role of serotonin in gastrointestinal motility and irritable bowel syndrome. Clin Chim Acta 403:47–55CrossRef
36.
Zurück zum Zitat Wu Q, Bencaz AF, Hentz JG, Crowell MD (2012) Selective serotonin reuptake inhibitor treatment and risk of fractures: a meta-analysis of cohort and case-control studies. Osteoporos Int 23:365–375CrossRef Wu Q, Bencaz AF, Hentz JG, Crowell MD (2012) Selective serotonin reuptake inhibitor treatment and risk of fractures: a meta-analysis of cohort and case-control studies. Osteoporos Int 23:365–375CrossRef
37.
Zurück zum Zitat Zhou C, Fang L, Chen Y, Zhong J, Wang H, Xie P (2018) Effect of selective serotonin reuptake inhibitors on bone mineral density: a systematic review and meta-analysis. Osteoporos Int 29:1243–1251CrossRef Zhou C, Fang L, Chen Y, Zhong J, Wang H, Xie P (2018) Effect of selective serotonin reuptake inhibitors on bone mineral density: a systematic review and meta-analysis. Osteoporos Int 29:1243–1251CrossRef
38.
Zurück zum Zitat Nevitt MC, Cummings SR, Stone KL, Palermo L, Black DM, Bauer DC, Genant HK, Hochberg MC, Ensrud KE, Hillier TA, Cauley JA (2005) Risk factors for a first-incident radiographic vertebral fracture in women > or = 65 years of age: the study of osteoporotic fractures. J Bone Miner Res 20:131–140CrossRef Nevitt MC, Cummings SR, Stone KL, Palermo L, Black DM, Bauer DC, Genant HK, Hochberg MC, Ensrud KE, Hillier TA, Cauley JA (2005) Risk factors for a first-incident radiographic vertebral fracture in women > or = 65 years of age: the study of osteoporotic fractures. J Bone Miner Res 20:131–140CrossRef
39.
Zurück zum Zitat Melton LJ 3rd, Hartmann LC, Achenbach SJ, Atkinson EJ, Therneau TM, Khosla S (2012) Fracture risk in women with breast cancer: a population-based study. J Bone Miner Res 27:1196–1205CrossRef Melton LJ 3rd, Hartmann LC, Achenbach SJ, Atkinson EJ, Therneau TM, Khosla S (2012) Fracture risk in women with breast cancer: a population-based study. J Bone Miner Res 27:1196–1205CrossRef
40.
Zurück zum Zitat Chen Z, Maricic M, Bassford TL, Pettinger M, Ritenbaugh C, Lopez AM, Barad DH, Gass M, Leboff MS (2005) Fracture risk among breast cancer survivors: results from the Women’s Health Initiative Observational Study. Arch Intern Med 165:552–558CrossRef Chen Z, Maricic M, Bassford TL, Pettinger M, Ritenbaugh C, Lopez AM, Barad DH, Gass M, Leboff MS (2005) Fracture risk among breast cancer survivors: results from the Women’s Health Initiative Observational Study. Arch Intern Med 165:552–558CrossRef
41.
Zurück zum Zitat Khosla S, Amin S, Orwoll E (2008) Osteoporosis in men. Endocr Rev 29:441–464CrossRef Khosla S, Amin S, Orwoll E (2008) Osteoporosis in men. Endocr Rev 29:441–464CrossRef
42.
Zurück zum Zitat Houghton LA, Jackson NA, Whorwell PJ, Morris J (2000) Do male sex hormones protect from irritable bowel syndrome? Am J Gastroenterol 95:2296–2300CrossRef Houghton LA, Jackson NA, Whorwell PJ, Morris J (2000) Do male sex hormones protect from irritable bowel syndrome? Am J Gastroenterol 95:2296–2300CrossRef
43.
Zurück zum Zitat Kim BJ, Rhee PL, Park JH, Chang DK, Kim YH, Son HJ, Kim JJ, Rhee JC, Lee H (2008) Male sex hormones may influence the symptoms of irritable bowel syndrome in young men. Digestion 78:88–92CrossRef Kim BJ, Rhee PL, Park JH, Chang DK, Kim YH, Son HJ, Kim JJ, Rhee JC, Lee H (2008) Male sex hormones may influence the symptoms of irritable bowel syndrome in young men. Digestion 78:88–92CrossRef
Metadaten
Titel
Risk of fractures at different anatomic sites in patients with irritable bowel syndrome: a nationwide population-based cohort study
verfasst von
Herng-Sheng Lee
Chi-Yi Chen
Wan-Ting Huang
Li-Jen Chang
Solomon Chih-Cheng Chen
Hsin-Yi Yang
Publikationsdatum
01.12.2018
Verlag
Springer London
Erschienen in
Archives of Osteoporosis / Ausgabe 1/2018
Print ISSN: 1862-3522
Elektronische ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-018-0496-7

Weitere Artikel der Ausgabe 1/2018

Archives of Osteoporosis 1/2018 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.