Knochenmineraldichtemessung in der klinischen Routine

Zusammenfassung

Die Osteoporose ist durch den Verlust an Knochenmineraldichte mit einem konsekutiv erhöhten Frakturrisiko gekennzeichnet. Zur Beurteilung des Frakturrisikos und der Einleitung einer medikamentösen Therapie sollte eine Knochenmineraldichtemessung durchgeführt werden. Die Dual Energy X-ray Absorptiometrie (DXA) stellt das nach den aktuellen Leitlinien empfohlene Verfahren zur Beurteilung der Knochenmineraldichte dar. Anhand des T-Scores, welcher durch eine DXA-Knochenmineraldichtemessung ermittelt wird, erfolgt die Abschätzung des Frakturrisikos, um die Notwendigkeit zur Durchführung einer medikamentösen Therapie individuell festzulegen. Die DXA bietet zudem die Möglichkeit, eine Beurteilung der Knochenstruktur unter Verwendung des Trabecular Bone Score vorzunehmen. Das Vorliegen von Wirbelkörperfrakturen kann mit dem „sogenannten“ Vertebral Fracture Assessment durch die DXA ebenfalls visualisiert werden. Als weitere Knochenmineraldichtemessverfahren konkurrieren die Quantitative Computertomografie und der Quantitative Ultraschall. Entsprechend der S3-Leitlinie „Osteoporose“ können diese Knochenmineraldichtemessverfahren allerdings die DXA-Technik nicht ersetzen und sollten nicht regelhaft zum Einsatz kommen.

Abstract

Osteoporosis is associated with reduced bone mineral density and an increased risk of fractures. Bone mineral density should be measured to evaluate the risk of fractures and to initiate drug treatment. Current guidelines recommend Dual Energy X-ray Absorptiometry (DXA) for the assessment of bone mineral density. Based on the DXA T-Score, the risk of fractures can be assessed and the indication for an individual treatment regimen established. Additionally, the DXA technique offers the possibility to evaluate the bone structure using the Trabecular Bone Score and to quantify vertebral fractures of the thoracic and lumbar spine by the Vertebral Fracture Assessment. Quantitative computed tomography and quantitative ultrasound are alternative techniques for the evaluation of bone mineral density. In due consideration of the S3 Guideline “Osteoporosis”, bone mineral density measurement by DXA cannot be replaced by these alternative techniques, which should only be used in exceptional well-defined cases.

Schlüsselwörter

Knochenmineraldichtemessung - Osteoporose - quantitativer Ultraschall - Dual Energy X-ray Absorptiometrie - quantitative Computertomografie

Key words

bone mineral density measurement - osteoporosis - quantitative ultrasound - dual energy X-ray absorptiometry - quantitative computed tomography

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