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Bildgebung der diabetischen Osteopathie

Imaging of diabetic osteopathy

Der Radiologe volume 55, pages 329–336 (2015)Cite this article

Zusammenfassung

Klinisches Problem

Die diabetische Osteopathie ist mehr als eine einfache Osteoporose des Diabetikers: Neben relativ hoher Knochendichte, aber dennoch paradox erhöhter Frakturanfälligkeit, ist die Erkrankung durch niedrigen Knochenumsatz, Osteozytendysfunktion, relativen Hypoparathyreoidismus und Akkumulation von „advanced glycation end products“ in der Knochenmatrix gekennzeichnet. Unter den klassischen Insuffizienzfrakturen finden sich gehäuft periphere Frakturen der unteren Extremität (z. B. Metatarsalia). Die korrekte, interdisziplinäre Bewertung des individuellen Frakturrisikos des einzelnen Patienten stellt eine klinische Herausforderung dar.

Radiologische Standardverfahren

Zur Ermittlung der Knochendichte stehen 2 State-of-the-art-Verfahren zur Verfügung: „dual energy X-ray absorptiometry“ (DXA) und quantitative Computertomographie (QCT). Für die Diagnostik von Insuffizienzfrakturen stehen Projektionsradiographie, Multidetektorcomputertomographie (MDCT) und Magnetresonanztomographie (MRT) zur Verfügung.

Methodische Innovationen und Leistungsfähigkeit

Neue Verfahren wie die hochauflösende periphere quantitative Computertomographie (HR-pQCT) bieten die Möglichkeit, die Mikroarchitektur des peripheren Skeletts ohne Biopsie zu untersuchen. Mit der MR-Spektroskopie können zusätzliche Informationen über die Zusammensetzung des diabetischen Knochenmarks gewonnen werden: Beide Techniken helfen bei der Differenzierung von Diabetikern mit und ohne prävalente Frakturen und stellen daher eine Verbesserung gegenüber den derzeit gültigen Standardverfahren dar, befinden sich allerdings noch im Versuchsstadium.

Empfehlung für die Praxis

DXA und QCT sind valide Verfahren zur Bestimmung der Knochendichte und Abschätzung des Frakturrisikos bei Patienten mit Diabetes mellitus im klinischen Gesamtkontext. Projektionsradiographie, CT und MRT eignen sich zur Frakturdiagnostik.

Abstract

Clinical issue

Diabetic bone diseases are more than just osteoporosis in patients with diabetes mellitus (DM): a relatively high bone mineral density is paired with a paradoxically high risk of fragility fractures. Diabetics exhibit low bone turnover, osteocyte dysfunction, relative hypoparathyroidism and an accumulation of advanced glycation end products in the bone matrix. Besides typical insufficiency fractures, diabetics show a high risk for peripheral fractures of the lower extremities (e.g. metatarsal fractures). The correct interdisciplinary assessment of fracture risks in patients with DM is therefore a clinical challenge.

Standard radiological methods

There are two state of the art imaging methods for the quantification of fracture risks: dual energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). Radiography, multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are suitable for the detection of insufficiency fractures.

Methodical innovations and performance

Novel research imaging techniques, such as high-resolution peripheral quantitative computed tomography (HR-pQCT) provide non-invasive insights into bone microarchitecture of the peripheral skeleton. Using MR spectroscopy, bone marrow composition can be studied. Both methods have been shown to be capable of discriminating between type 2 diabetic patients with and without prevalent fragility fractures and thus bear the potential of improving the current standard of care. Currently both methods remain limited to clinical research applications.

Practical recommendations

DXA and HR-pQCT are valid tools for the quantification of bone mineral density and assessment of fracture risk in patients with DM, especially if interpreted in the context of clinical risk factors. Radiography, CT and MRI are suitable for the detection of insufficiency fractures.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Patsch, P. Pietschmann, C. Schueller-Weidekamm geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Affiliations

  1. Abteilung für Allgemeine Radiologie und Kinderradiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18–10, 1090, Wien, Österreich

    J. Patsch PhD

  2. Institut für Pathophysiologie und Allergieforschung, Zentrum für Pathophysiologie, Infektiologie und Immunologie , Medizinische Universität Wien, Wien, Österreich

    P. Pietschmann

  3. Abteilung für Neuroradiologie und Muskuloskelettale Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Wien, Österreich

    C. Schueller-Weidekamm

Authors
  1. J. Patsch PhD
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  2. P. Pietschmann
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  3. C. Schueller-Weidekamm
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Correspondence to J. Patsch PhD.

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Patsch , J., Pietschmann, P. & Schueller-Weidekamm, C. Bildgebung der diabetischen Osteopathie. Radiologe 55, 329–336 (2015). https://doi.org/10.1007/s00117-014-2723-6

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  • DOI: https://doi.org/10.1007/s00117-014-2723-6

Schlüsselwörter

  • Diabetes mellitus
  • Diabetische Osteopathie
  • HR-pQCT
  • Spektroskopie
  • Kortikale Porosität

Keywords

  • Diabetes mellitus
  • Diabetic bone disease
  • High resolution peripheral quantitative computed tomography
  • MR spectroscopy
  • Cortical porosity