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Prävalenz und Management der Osteoporose in der Unfallchirurgie

Umsetzung der DVO-Empfehlungen in der stationären Frakturbehandlung

Prevalence and management of osteoporosis in trauma surgery

Implementation of national guidelines during inpatient fracture treatment

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Zusammenfassung

Hintergrund

Osteoporoseassoziierte Frakturen bedeuten ein gesteigertes Risiko, weitere Fragilitätsfrakturen zu erleiden. Daher sollte spätestens während der stationären unfallchirurgischen Behandlung eine leitliniengerechte Osteoporosediagnostik und -therapie eingeleitet werden.

Material und Methoden

Über 2 Jahre wurden Frauen > 50 und Männer > 60 Jahre prospektiv erfasst, die aufgrund von Frakturen der Brustwirbelsäule/Lendenwirbelsäule, des proximalen Femurs, des proximalen Humerus und des distalen Radius stationär behandelt wurden.

Ergebnisse

Von 455 eingeschlossenen Patienten erhielten 65,9 % eine DXA-Messung (Dual-X-Ray-Absorptiometrie), davon Frauen in 69,5 % und Männer signifikant seltener in 52,1 %. Eine Osteoporose lag in 56,6 % vor, dabei waren Frauen zu 56,2 % und Männer zu 59 % betroffen. In 83,8 % handelte es sich um eine Erstdiagnose. Nach einer DXA wurde in 86,7 % eine leitliniengerechte Therapie gemäß des Dachverbandes Osteologie eingeleitet. In der Altersgruppe der Frauen > 70 und Männer > 80 Jahre war in 77,1 % eine spezifische Therapie indiziert.

Schlussfolgerung

Beim Großteil der alten Patienten mit Fraktur liegt geschlechtsunabhängig eine Osteoporose vor. Auch heute noch ist die Osteoporose bis zum Frakturereignis in den allermeisten Fällen unerkannt und unbehandelt. Daher kommt dem behandelnden Unfallchirurg in der Diagnosesicherung und Therapieeinleitung eine Schlüsselfunktion zu.

Abstract

Background

Osteoporosis-associated fractures represent a risk factor for developing further fragility fractures. Therefore, guideline-oriented osteoporosis intervention is of utmost importance during inpatient fracture treatment.

Patients and methods

Women >50 years and men >60 years with fractures of the lumbar or thoracic spine, proximal femur, proximal humerus and distal radius were included in a prospective study. We analyzed the initiation of diagnosis and treatment of osteoporosis during the inpatient stay.

Results

A total of 455 patients were included and bone mineral density measurement (DXA) was carried out in 65.9 %. Women underwent DXA in 69.5 % and men significantly less frequently in 52.1 %. Osteoporosis was diagnosed in 56.6 %, where women were affected in 56.2 % and men in 59 % of cases. In 83.8 % osteoporosis had been previously unknown. Treatment according to the guidelines of the Organisation of German Scientific Osteology-related Societies (DVO) was initiated in 86.7 % and 77.1 % of women >70 years and men >80 years required anti-resorptive treatment after DXA.

Conclusions

The majority of elderly patients with fractures also suffer from osteoporosis, independent of gender. Even nowadays, osteoporosis is predominantly not diagnosed until the incidence of a fracture. Therefore, the trauma surgeon is in a key position to initiate diagnosis and treatment of osteoporosis.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. F. Haasters, W.C. Prall, M. Himmler, H. Polzer, M. Schieker und W. Mutschler geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren. Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Authors and Affiliations

  1. Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie, Klinikum der Universität München, Nussbaumstraße 20, 80336, München, Deutschland

    F. Haasters, W.C. Prall, M. Himmler, H. Polzer, M. Schieker & W. Mutschler

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  1. F. Haasters
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  2. W.C. Prall
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Correspondence to F. Haasters.

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Haasters, F., Prall, W., Himmler, M. et al. Prävalenz und Management der Osteoporose in der Unfallchirurgie. Unfallchirurg 118, 138–145 (2015). https://doi.org/10.1007/s00113-013-2500-4

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