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Frakturen und Knochendichte im Kindesalter

Fractures and bone mineral density in childhood

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Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Bei entzündlichen Gelenkerkrankungen wird durch die proinflammatorischen Zytokine die Knochenformation beeinträchtigt und der Knochenabbau stimuliert. Entzündungshemmende Medikamente wie Glukokortikoide und NSAR (nichtsteroidale Antirheumatika) haben zudem das Potenzial, das Wachstum und den Erhalt des Knochens zu hemmen. Im Kindesalter und in der Adoleszenz sind diese Phänomene für das wachsende Skelett von besonderer Bedeutung.

Ziel der Arbeit

In dieser Übersicht sollen die Kenntnisse über das Ausmaß des Problems zusammengefasst, diagnostische Verfahren kritisch beleuchtet und mögliche therapeutische Maßnahmen diskutiert werden.

Methoden

Eine systematische Literaturrecherche zum Thema wurde durchgeführt und die Evidenz auf dem Boden der Expertenmeinung der Autoren festgestellt.

Ergebnisse und Diskussion

In den letzten Jahren wurden gute Daten zur Interpretation der Knochendichte bei Kindern und Adoleszenten erarbeitet, die es erlauben, unter Einbeziehung der aktuellen Entwicklungsphase und Körperlänge und in Abwägung der sehr niedrigen Strahlenbelastung die Messung der Knochenflächendichte mittels DXA (Dual-energy-X-ray-Absorption) zur Diagnostik und Risikoevaluation klinisch einzusetzen. Dabei sind dynamische Entwicklungen der Knochenflächendichte über die Zeit in Zusammenschau mit anderen klinischen Parametern besonders aussagekräftig. Insbesondere bei juveniler idiopathischer Arthritis und anderen Erkrankungen des rheumatischen Formenkreises ist die Messung zur Überwachung der Knochengesundheit hilfreich. Sie kann zur Indikation erweiterter Diagnostik und zur Indikation spezifischer pharmakologischer Therapie mit knochenwirksamen Medikamenten beitragen, ebenso aber auch zur Gestaltung präventiver Maßnahmen wie ausreichender Zufuhr von Kalzium und Vitamin D und gezielter Trainingsinterventionen. Kinder mit chronisch entzündlichen Erkrankungen tragen auch in Zeiten hochwirksamer Antirheumatika ein Risiko für ihre Knochengesundheit.

Abstract

Background

In juvenile idiopathic arthritis and related chronic inflammatory diseases, proinflammatory cytokines inhibit bone formation and stimulate bone resorption. Anti-inflammatory drugs, such as glucocorticoids and nonsteroidal antirheumatic drugs (NSARD) have as a side effect the potential to inhibit growth and maintenance of bone. These issues are of particular importance for the growing skeleton in childhood and adolescence.

Objective

This article presents a narrative overview about the dimension of the problem, a critical evaluation of diagnostic procedures and a discussion of available countermeasures.

Methods

A systematic literature search was carried out and the available evidence was evaluated based on the authors’ knowledge and clinical experience as experts in the field.

Results and conclusion

In recent years solid data have been accumulated with respect to the interpretation of bone mineral density (BMD) measurements in children and adolescents. Based on these data from the literature and given that the radiation exposure is also very low, it is now possible to clinically apply BMD measurements in this population using dual energy X‑ray absorption (DXA) technology for risk evaluation and diagnosis, taking the respective phase of development and body length into consideration. Dynamic measurements over time appear to be especially valuable in the context of individual clinical data. Hence, BMD measurements can be helpful in monitoring bone health, especially in juvenile idiopathic arthritis and other related inflammatory diseases. Apart from the specific indications for extended diagnostics and bone targeted pharmacological treatment, this method can also contribute to the management of preventive measures, such as sufficient calcium and vitamin D intake and targeted exercise interventions. Even in times of extremely effective antirheumatic drugs, children with chronic inflammatory diseases still bear a risk for bone health.

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Author information

Authors and Affiliations

  1. Kinderklinik und Poliklinik, Pädiatrische Rheumatologie und Osteologie, Universitätsklinikum Würzburg, Würzburg, Deutschland

    Christine Hofmann

  2. Klinik für Kinder- und Jugendmedizin, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland

    Herrmann Girschick

  3. Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland

    Constantin Lapa

  4. Medizinische Fakultät und Uniklinik Köln, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universität zu Köln, Köln, Deutschland

    Oliver Semler

  5. Orthopädische Klinik im König-Ludwig-Haus, Bernhard-Heine-Centrum für Bewegungsforschung, Brettreichstr. 11, 97074, Würzburg, Deutschland

    Franz Jakob

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  1. Christine Hofmann
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  2. Herrmann Girschick
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Correspondence to Franz Jakob.

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Interessenkonflikt

C. Hofmann, H. Girschick, C. Lapa, O. Semler und F. Jakob geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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H.-I. Huppertz, Bremen

K. Minden, Berlin

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Hofmann, C., Girschick, H., Lapa, C. et al. Frakturen und Knochendichte im Kindesalter. Z Rheumatol 78, 636–644 (2019). https://doi.org/10.1007/s00393-019-0671-2

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  • DOI: https://doi.org/10.1007/s00393-019-0671-2

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