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Knochendichtemessungen bei entzündlich-rheumatischen Erkrankungen

Besonderheiten der Messorte und krankheitsspezifische Einflussfaktoren

Bone densitometry in inflammatory rheumatic diseases

Characteristics of the measurement site and disease-specific factors

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Zusammenfassung

Die Indikation zu Knochendichtemessungen sollte bei Patienten mit entzündlich-rheumatischen Erkrankungen früher als üblich gestellt werden, da Faktoren wie Entzündungsaktivität und medikamentöse Therapie, besonders die Einnahme von Glukokortikoiden, einen entscheidenden Einfluss bei der Entwicklung einer Osteoporose haben. Die DXA („Dual energy X-ray Absorptiometry“) hat sich als Goldstandard der Knochendichtemessung bewährt. Entsprechend den DVO-Richtlinien spielt die Knochendichtemessung bei der Frage der Therapie eine entscheidende Rolle.

Bei der rheumatoiden Arthritis (RA) empfiehlt sich neben der Messung an der LWS und der Hüfte besonders die gelenknahe Messung am Unterarm, um eine begleitende periphere Osteoporose zu erfassen. Die DXA-Messung der Hand erlaubt, eine lokale Osteoporose früh zu diagnostizieren, ist jedoch noch nicht als Standard etabliert.

Bei der Spondylitis ankylosans (AS) kann zu Beginn der Erkrankung eine DXA-Messung der LWS und der Hüfte durchgeführt werden. Die Knochendichte ist beim systemischen Lupus erythematodes insbesondere bei hoher Entzündungsaktivität häufiger erniedrigt. Bei der Psoriasisarthritis lässt eine sich eine Osteoporose meist beim osteodestruktiven Verlauf finden.

Abstract

Bone densitometry should be performed earlier in patients with inflammatory arthritis, since factors such as inflammation and drug therapy, in particular treatment with glucocorticoids, have an important impact on the development of osteoporosis. DXA (Dual energy X-ray Absorptiometry) is considered the gold standard for bone densitometry. According to the German guidelines for osteoporosis, bone densitometry plays a crucial role in the choice of therapy.

In patients with rheumatoid arthritis, measurement of peripheral bone (forearm) density in addition to lumbar spine and hip is recommended, since local bone loss is pathognomonic for this disease. DXA measurements of the hand enable the diagnosis of juxtaarticular osteoporosis at an earlier stage; however, this has not yet been established in routine practise.

Bone measurement in patients with ankylosing spondylitis can be performed in the lumbar spine and the hip at disease onset. In systemic lupus erythematosus, bone loss is more frequent in patients with high inflammatory activity. Patients with psoriasis arthritis frequently have osteoporosis in the case of a destructive development of the joints.

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Authors and Affiliations

  1. Schwerpunktpraxis Rheumatologie, Godesberger Allee 90, 53175, Bonn, Deutschland

    H. Franck

  2. Rheumazentrum Ruhrgebiet, Herne, Deutschland

    J. Braun

  3. Medizinische Universitätsklinik m.S. Rheumatologie, Charite-Universitätsmedizin Berlin, Berlin, Deutschland

    F. Buttgereit

  4. Rheumazentrum Hildesheim, Hildesheim, Deutschland

    W. Demary

  5. Klinik für Innere Med.3, Rheumatologie & Osteologie, Universitätsklinikum Jena, Jena, Deutschland

    G. Hein

  6. Rheumatologie und Orthopädie der Otto-von-Guericke-Universität Magdeburg, Vogelsang bei Gommern, Deutschland

    J. Kekow

  7. Universitätsklinik für Innere Medizin 3; Rheumatologie und Immunologie, Universität Erlangen- Nürnberg, Erlangen, Deutschland

    G. Schett

  8. Capio Franz von Prümmer Klinik, Bad Brückenau, Deutschland

    P.M. Kern

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Franck, H., Kommission Osteologie der Deutschen Gesellschaft für Rheumatologie., Braun, J. et al. Knochendichtemessungen bei entzündlich-rheumatischen Erkrankungen. Z. Rheumatol. 68, 845–850 (2009). https://doi.org/10.1007/s00393-009-0502-y

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