Bildgebende Verfahren, Knochendichtemessung und quantitativer Ultraschall

Zusammenfassung

Die bildgebende Diagnostik der Osteoporose erfolgt vorwiegend durch das Röntgenbild. Dadurch können bereits eingetretene Wirbelkörperfrakturen nachgewiesen werden. Eine Frühdiagnostik, also eine Diagnose vor der ersten Wirbelkörperfraktur, kann mit der Osteodensitometrie erfolgen. Als mögliche Verfahren stehen die Zwei-Energie Röntgenschwächungsmessungen und die quantitativen Computertomographien am Stammskelett und am Radius zur Verfügung. Der quantitative Ultraschall steht noch in der wissenschaftlichen Erprobung, zeigt aber perspektivisch hoffnungsvolle Ergebnisse.

Pathophysiology of Primary Osteoporosis

X-ray imaging of the thoracic and lumbar spine is the only imaging method for diagnosing vertebral fracture. As a result of administrative restrictions in Germany, it is no longer possible to effect an early diagnosis of bone density loss before the first fracture occurs. Nevertheless, bone density measurement methods rank highly in osteoporosis diagnostics. Quantitative ultrasound is still under research scrutiny as a diagnostic tool for examining an osteoporotic bone. Although there are highly promising approaches, we believe the method is not yet fully substantiated.

Literatur

• 1 Babaiantz L. Les osteoporoses.  Radiolog Clin (Basel). 1947;  16 291-322
• 2 Bauer D C, Glüer C C, Cauley J A, Vogt T M, Ensrud K E, Genant H K, Black D M. Broadband Ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. A prospective study of the Osteoporotic Fractures Research Group.  Arch Intern Med. 1997;  157 629-634
• 3 Black D M, Palermo L, Nevitt M C, Genant H K, Christensen L, Cummings S R. Defining incident vertebral deformity: a prospective comparison of several approaches. The Study of Osteoporotic Fractures Research Group.  J Bone Miner Res. 1999;  14 90-101
• 4 Eastell R, Cedel S L, Wahner H W, Riggs B L, Melton L J III. Classification of vertebral fractures.  J Bone Miner Res. 1991;  6 207-215
• 5 Felsenberg D, Wieland E, Gowin W, Armbrecht G, Bolze X, Khorassani A, Weingarten U. Morphometric analysis of roentgen images of the spine for diagnosis of osteoporosis-induced fracture.  Med Klin. 1998;  93 26-30
• 6 Fordham J N, Chinn D J, Kumar N. Identification of women with reduced bone density at the lumbar spine and femoral neck using BMD at the os calcis.  Osteoporos Int. 2000;  11 797-802
• 7 Frost M L, Blake G M, Fogelman I. Can the WHO criteria for diagnosing osteoporosis be applied to calcaneal quantitative ultrasound?.  Osteoporos Int. 2000;  11 321-330
• 8 Genant H K, Wu C Y, van Kuijk C, Nevitt M C. Vertebral fracture assessment using a semiquantitative technique.  J Bone Miner Res. 1993;  8 1137-1148
• 9 Glüer C C. How to characterize the ability of a diagnostic technique to monitor skeletal changes (Abstract).  J Bone Miner Res. 1997;  12 378
• 10 Gonnelli S, Cepollaro C, Pondrelli C, Martini S, Rossi S, Gennari C. Ultrasound parameters in osteoporotic patients treated with salmon calcitonin: a longitudinal study.  Osteoporos Int. 1996;  6 303-307
• 11 Gonnelli S, Montagnani A, Cepollaro C, Monaco R, Gennari L, Rossi B, Pacini S, Gennari C. Quantitative ultrasound and bone mineral density in patients with primary hyperparathyroidism before and after surgical treatment.  Osteoporos Int. 2000;  11 255-260
• 12 Grampp S, Lang P, Jergas M, Glüer C C, Mathur A, Engelke K, Genant H K. Assessment of the skeletal status by peripheral quantitative computed tomography of the forearm: short-term precision in vivo and comparison to dual X-ray absorptiometry.  J Bone Miner Res. 1995;  10 1566-1576
• 13 Hans D, Dargent-Molina P, Schott A M, Sebert J L, Cormier C, Kotzki P O, Delmas P D, Pouilles J M, Breart G, Meunier P J. Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study.  Lancet. 1996;  348 511-514
• 14 Jergas M, Schmid G. The role of quantitative ultrasound versus other techniques in osteoporosis assessment. In: Njeh CF et al. (Eds) Qualitative Ultrasound - Assessment of Osteoporosis and bone status. London; Martin Dunitz 1999: 245
• 15 Jorgensen J T, Andersen P B, Rosholm A, Bjarnason N H. Digital X-ray radiogrammetry: a new appendicular bone densitometric method with high precision.  Clin Physiol. 2000;  20 330-335
• 16 Lachmann E, Whelan M. The roentgen diagnosis of osteoporosis and its limitations.  Radiology. 1935;  25 165
• 17 Langton C M, Langton D K. Comparison of bone mineral density and quantitative ultrasound of the calcaneus: site-matched correlation and discrimination of axial BMD status.  Br J Radiol. 2000;  73 31-35
• 18 Mauloni M, Rovati L C, Cadosi R, de Terlizzi F, Ventura V, de Aloysio D. Monitoring bone effect of transdermal hormone replacement therapy by ultrasound investigation at the phalanx: a four-year follow-up study.  Menopause. 2000;  7 402-412
• 19 McCloskey E V, Spector D T, Eyres K S, Fer E D, O’Rourke N, Vasikaran S, Kanis J A. The assessment of vertebral deformity: a method for use in population studies and clinical trials.  Osteoporos Int. 1993;  3 138-147
• 20 Minne H W, Leidig G, Wüster C. A newly developed spine deformity index (SDI) to quantitative vertebral crush fractures in patients with osteoporosis.  Bone and Mineral. 1988;  3 335-349
• 21 Nicholson P HF, Bouxsein M L. Ultrasonic studies of cortical bone in vitro. In: Njeh CF et al. (Eds). Qualitative Ultrasound - Assessment of Osteoporosis and bone status. London; Martin Dunitz 1999: 177-193
• 22 Nicholson P HF, Njeh C F. Ultrasonic studies of cancellous bone in vitro. In: Njeh CF et al. (Eds). Qualitative Ultrasound - Assessment of Osteoporosis and bone status. London; Martin Dunitz 1999: 195-219
• 23 Rosenthall L, Caminis J, Tenenhouse A. Calcaneal ultrasonometry: response to treatment compared to DXA of the lumbar spine and femur.  J Bone Miner Res. 1997;  12 120
• 24 Roux C, Giorgino R. Quantitative ultrasound for monitoring bone changes. In: Njeh CF et al. (Eds) Qualitative Ultrasound - Assessment of Osteoporosis and bone status. London; Martin Dunitz 1999: 299-307
• 25 Sahota O, San P, Cawte S A, Pearson D, Hosking D J. A comparison of the longitudinal changes in quantitative ultrasound with dual-energy X-ray absorptiometry: the four-year effects of hormone replacement therapy.  Osteoporos Int. 2000;  11 52-58
• 26 World Health Organization . Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group.  World Health Organ Tech Rep Ser. 1994;  843 1-129
• 27 Wu C Y, Li J, Jergas M, Genant H K. Comparison of semiquantitative and quantitative techniques for the assessment of prevalent and incident vertebral fractures.  Osteoporos Int. 1995;  5 354-370
• 28 Heaney R P, Avioli L V, Chesnut C H, Lappe J, Recker R R, Brandenburger G H. Ultrasound velocity, through bone predicts incident vertebral deformity.  J Bone Miner Res. 1995;  10 341-345