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Osteoporose in der Unfallchirurgie

Prävalenz und Management

Osteoporosis in traumatology

Prevalence and management

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Zusammenfassung

Hintergrund

Eine Fraktur stellt im Krankheitsverlauf der Osteoporose ein Schlüsselereignis dar, führt jedoch nur selten zu Knochendichtemessung oder suffizienter Osteoporosetherapie. Ziel dieser Untersuchung war die Feststellung der Osteoporoseprävalenz älterer Patienten mit operationspflichtiger Extremitätenfraktur und die Überprüfung der Akzeptanz eines Algorithmus für die Diagnostik und Therapie osteoporosebedingter Frakturen innerhalb einer unfallchirurgischen Abteilung und die Evaluation seiner Nachhaltigkeit.

Patienten und Methoden

Innerhalb eines Jahres sollten anhand des Algorithmus alle Frauen >50 Jahre und alle Männer >75 Jahre mit operationspflichtiger Extremitätenfraktur nach der Operation prospektiv einer Knochendichtemessung (DXA) unterzogen werden. Ermittelt wurde der Anteil der tatsächlich in die Untersuchung eingeschlossenen Patienten, deren Knochendichtestatus, die Einleitung einer leitliniengerechten Therapie sowie die Therapiefortführung bei Patienten mit einer stationären Reha-Maßnahme.

Ergebnisse

Zwischen Mai 2003 und April 2004 erfüllten 228 Patienten die Kriterien zur Durchführung der DXA, von denen 169 (74,1%) Patienten in die Untersuchung eingeschlossen wurden. Nach den Kriterien der WHO zeigten 71,6% der Patienten eine manifeste Osteoporose und 24,3% der Patienten eine Osteopenie. Mit Hilfe des Algorithmus gelang es in 84% der Fälle die Therapie noch während des stationären Aufenthalts einzuleiten. In 74,4% wurde die Therapie während der Rehabilitation fortgeführt.

Schlussfolgerung

Bei der Mehrheit der älteren Patienten in der Unfallchirurgie lässt sich als wesentliche Mitursache ihrer Fraktur eine Osteoporose nachweisen. Mit Hilfe eines standardisierten Behandlungsschemas kann der größte Teil dieser Patienten einer leitliniengerechten Diagnostik und Therapie zugeführt werden.

Abstract

Background

A fracture occurring in osteoporosis is a sentinel event but very rarely leads to bone mineral density (BMD) measurement or sufficient drug therapy. We designed an algorithm to evaluate BMD in older fracture patients and tested it for sustainability as well as acceptance among trauma/orthopedic surgeons.

Methods

For a 1-year period a prospective BMD test was carried out in women older than 50 and men older than 75 years of age with fractures. The commencement and conduction of therapy during the initial hospital stay and rehabilitation were also analyzed.

Results

From 228 members of the eligible age groups, 169 patients (74.1%) underwent BMD measurement. According to the WHO definition 71.6% showed reduced BMD in terms of osteoporosis and 24.3% in terms of osteopenia. In 84% therapy was started during initial hospital stay in 74.4% conducted during rehabilitation.

Conclusions

The vast majority of older patients exhibited reduced BMD as a substantial underlying cause of their fracture. A standardized clinical plan can help to identify and treat most patients with fragility fractures.

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Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Ludwig-Maximilian-Universität, München-Innenstadt

    T. Vogel, T. Dobler, P. Biberthaler, K.-G. Kanz & W. Mutschler

  2. Institut für Klinische Radiologie, Ludwig-Maximilian-Universität, München

    H. Bitterling & K.-J. Pfeifer

  3. Bayerisches Osteoporosezentrum, Medizinische Klinik III, Klinikum der Universität, München-Großhadern

    R. Bartl

  4. Chirurgische Klinik und Poliklinik, Ludwig-Maximilian-Universität, Nussbaumstraße 20, 80336, München

    T. Vogel

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  1. T. Vogel
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  2. T. Dobler
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  3. H. Bitterling
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  7. R. Bartl
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Correspondence to T. Vogel.

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Vogel, T., Dobler, T., Bitterling, H. et al. Osteoporose in der Unfallchirurgie. Unfallchirurg 108, 356–364 (2005). https://doi.org/10.1007/s00113-005-0927-y

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