Erworbene Störungen des Skelettsystems

S. Bechtold-Dalla Pozza

doi:10.1055/s-0038-1630115

Osteologie, Table of Contents

Osteologie 2013; 22(02): 108-112
DOI: 10.1055/s-0038-1630115

Osteologie des Kindes- und Jugendalters

Schattauer GmbH

Erworbene Störungen des Skelettsystems

Osteoporose und Rachitis/OsteomalazieAcquired disturbance of the skeletal systemOsteoporosis and rickets/osteomalacia

Authors

S. Bechtold-Dalla Pozza

¹Pädiatrische Endokrinologie/Diabetologie, Dr. von Haunersches Kinderspital der LMU München

Abstract

Zusammenfassung

Die Osteoporose stellt ein weltweites Gesundheitsproblem dar. Im Kindesalter tritt sie sehr viel seltener als im Erwachsenenalter auf, die Ursachen sind mannigfaltig. Bisher wurden zahlreiche Kandidatengene für die Knochendichte gefunden, die mit der individuellen Knochendichte assoziiert zu sein scheinen. Neben der primären Osteoporose gibt es eine Vielzahl von Erkrankungen, die von einer sekundären Osteoporose begleitet werden. Die zugrundeliegenden Pathomechanismen sind vielseitig. Unter anderem greifen Zytokine in das Gleichgewicht zwischen Osteoblasten und Osteoklasten ein. Neben krankheitsbedingtem Knochenmasseverlust beeinflussen Lebensstil und Ernährungsverhalten die Knochenentwicklung. Bei mehr als 60 Prozent der Kinder und Jugendlichen in Deutschland liegt eine ungenügende Versorgung mit Vitamin D vor. In schwereren Fällen kann es zu einer Rachitis, bei verschlossenen Wachstumsfugen zu einer Osteomalazie kommen. Neben einer frühen Diagnose einer Störung der Knochenentwicklung sind präventive und therapeutische Strategien notwendig, um die Knochen gesundheit im Kindesalter zu erhalten.

Summary

Osteoporosis is a well-known worldwide health problem. Usually adults, especially the elderly, are affected. However, children could also develop osteoporosis or less severe forms of reduced bone mass. The underlying pathomechanism is multifactorial. Several candidate genes have been found being associated with lower bone mineral density. Besides primary osteoporosis forms a large number of chronic diseases are accompanied by bone loss. The child may not reach his or her genetically-determined peak bone mass or develop fractures. The mechanism involved in the pathogenesis of secondary bone loss includes among others elevated cytokines influencing the balance between modelling and remodelling. Glucocorticoid induced osteoporosis is the most common form of secondary osteoporosis. Glucocorticoids have direct and indirect effects on the skeleton. They impair the replication, differentiation and function of osteoblasts and induce apoptosis of mature osteoblasts and osteocytes, leading to suppression of bone formation. Glucocorticoids promote osteoclastogenesis and therefore increase bone resorption. Besides disease related bone loss, lifestyle changes including food and amount of weight bearing activity have an influence on bone health. Due to a survey in Germany about 60 % of children and adolescents have insufficient vitamin D levels leading possibly to rickets or osteomalacia, especially those with a migration background. Early recognition as well as preventive and therapeutic strategies are warranted to provide bone health in children.

Schlüsselwörter

Osteoporose - Rachitis - Osteomalazie - Glukokortikoide - Zytokine

Keywords

Osteoporosis - rickets - osteomalacia - glucocorticoids - cytokines

Full Text

References

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