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Osteopathien und Knochenstoffwechselerkrankungen

Klinische Bedeutung für die Frakturbehandlung

Pathological and metabolic bone diseases

Clinical importance for fracture treatment

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Zusammenfassung

Osteopathien und Knochenstoffwechselerkrankungen sind insgesamt häufig, werden aber im orthopädischen/unfallchirurgischen Alltag meist unzureichend adressiert! Das Symptom „Fraktur“ sollte Anlass sein, eine ursächliche Knochenstoffwechselstörung zu diagnostizieren und ggf. zu therapieren, um eine optimale Frakturheilung zu gewährleisten und Folgefrakturen zu verhindern. Im vorliegenden Artikel werden die Osteoporose, Osteopetrose, Hypophosphatasie und der Morbus Paget beispielhaft besprochen.Bei osteoporotischer Wirbelkörper- bzw. proximaler Femurfraktur muss neben der operativen Therapie auch die medikamentöse Behandlung der Grunderkrankung erfolgen. Da der Osteopetrose Defekte der osteoklastären Resorption zugrunde liegen, ist trotz pathologisch erhöhter Knochenmasse die Basistherapie mit Vitamin D3 und ggf. Kalzium entscheidend, um Hypokalzämien zu vermeiden. Diffuse muskuloskelettale Beschwerden – vor allem in Kombination mit Stressfrakturen – sollten an das Vorliegen einer Hypophosphatasie denken lassen und eine Bestimmung der alkalischen Phosphatase (AP) nach sich ziehen. Für den Morbus Paget, der oft durch eine erhöhte AP auffällt, stellen Bisphosphonate weiterhin die Therapie der Wahl dar.

Abstract

Pathological and metabolic bone diseases are common and relevant occurrences in orthopedics and trauma surgery; however, fractures are often treated as being the illness itself and not seen as the symptom of an underlying bone disease. This is why further diagnostics and systemic treatment options are often insufficiently considered in the routine treatment of fractures. This review focuses on osteoporosis, osteopetrosis, hypophosphatasia and Paget’s disease of bone.In patients with osteoporotic vertebral or proximal femur fractures, pharmaceutical treatment to prevent subsequent fractures is an integral part of fracture therapy together with surgical treatment. Osteopetrosis is caused by compromised osteoclastic bone resorption; therefore, even in the face of an elevated bone mass, vitamin D3 supplementation is crucial to avoid clinically relevant hypocalcemia. Unspecific symptoms of the musculoskeletal system, especially together with stress fractures, are typically found in patients suffering from hypophosphatasia. In these patients measurement of alkaline phosphatase shows reduced enzyme activity. Elevated levels of alkaline phosphatase are found in Paget’s disease of bone where bisphosphonates are still the treatment of choice.

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23562, Lübeck, Deutschland

    R. Oheim

  2. Institut für Osteologie und Biomechanik, Universitätsklinikum Hamburg-Eppendorf, Lottestrasse 59, 22529, Hamburg, Deutschland

    R. Oheim

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Oheim, R. Osteopathien und Knochenstoffwechselerkrankungen. Unfallchirurg 118, 1007–1016 (2015). https://doi.org/10.1007/s00113-015-0094-8

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