Metabolische Erkrankungen in der Osteologie

Zusammenfassung

Metabolische Erkrankungen des Knochenstoffwechsels führen zur einer Veränderung der Knochenstabilität. Die Knochenstabilität beschreibt die Frakturresistenz des Knochens und wird durch 3 Faktoren bestimmt: Quantität, Qualität und Umsatz. Die Knochenquantität kann mithilfe der Osteodensitometrie (Dual-energy X-Ray Absorptiometrie, DXA) als Knochenmineraldichte ermittelt werden. Die DXA gilt als anerkanntes Verfahren zur Ermittlung des Frakturrisikos. Struktur- und Materialbedingungen des Knochens definieren dagegen die Knochenqualität. Der postmenopausale Östrogenmangel gehört sicherlich zu den häufigsten und bekanntesten Risikofaktoren für die Entwicklung einer Osteoporose. Aber auch andere, seltenere Krankheitsbilder können sich auf die Knochenqualität in Form von Störungen von Mineralhomöostase, Knochenumbau und Kollagensynthese auswirken. Diese Erkrankungen und die Anzahl daran erkrankter Patienten werden dagegen unterschätzt und häufig nicht rechtzeitig diagnostiziert. Von allen Osteoporosepatienten sind rund 20–30% der postmenopausalen Frauen, 50% der prä- und perimenopausalen Frauen und 50% aller Männer von zugrundeliegenden Erkrankungen und Risikofaktoren betroffen, die zur Osteoporose führen. Neben den hormonassoziierten, medikamenten- und alkoholinduzierten Ursachen gehören metabolische Erkrankungen bei diesen Patienten zu den wichtigsten Risikofaktoren für die Entwicklung einer Osteoporose. Diese Erkrankungen können angeboren oder erworben sein. Viele primär hormonelle Störungen führen z. B. zu Störungen in der metabolischen Homöostase mit daraus resultierenden osteologischen Strukturveränderungen (u. a. Diabetes mellitus, Hyper- und Hypoparathyreoidisimus, usw.). Die folgende Übersicht stellt exemplarisch einige häufige und seltene metabolische Veränderungen dar, die im Praxisalltag auftreten und an die differenzialdiagnostisch gedacht werden sollte.

Abstract

Metabolic diseases of bone metabolism lead to changes in the stability of the bone. The stability of bone describes the fracture resistance of the bone and is determined by 3 factors: quantity, quality and turnover. Bone quality can be determined with the help of osteodensitometry (dual-energy X-ray absorptiometry, DXA) as the bone mineral density. DXA is an established procedure for measuring facture risk. The structural and mineral status of bone, on the other hand, defines bone quality. Postmenopausal Oestrogen deficiency is certainly one of the most frequent and best known risk factors for the development of osteoporosis. But other rare clinical entitites may also have an effect on bone quality in the form of disorders of mineral homeostasis, bone remodelling, and collagen synthesis. These diseases and the number of persons suffering from them are often underestimated and frequently not diagnosed in good time. Among all patients with osteoporosis, about 20–30% of the postmenopausal women, 50% of the pre- and perimenopausal women and 50% of all men are affected by the underlying diseases and risk factors that lead to osteoporosis. Apart from the hormone-associated as well as drug- and alcohol-induced causes, metabolic diseases belong to the most important risk factors for the development of osteoporosis. These diseases can be hereditary or acquired. Many primary hormonal disorders lead to, e. g., dysfunctions in metabolic homeostasis with the thus resulting osteological structural changes (among others, diabetes mellitus, hyper- and hypoparathyroidism, etc.). The present review exemplarily describes some frequent and some rare metabolic changes that may arise in the daily clinical routine and which should be considered in differential diagnoses.

Schlüsselwörter

Osteologie - Osteoporose - metabolische Erkrankungen

Key words

osteology - osteoporosis - metabolic diseases

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