Diagnostik der Osteoporose

Zusammenfassung

Die klinisch-körperliche Untersuchung, die Knochendichtemessung und radiomorphometrische Verfahren sind die Hauptstützen der Osteoporosediagnostik. Eine begrenzte Zahl einfacher Laborparameter reicht meistens aus, um sekundäre Formen einer Osteoporosen und eine Osteomalazie abzugrenzen. Knochenspezifische Umbauparameter spielen eine wachsende Rolle beim Therapiemonitoring. Sie könnten in den kommenden Jahren auch eine Rolle in der Therapieentscheidung spielen. Bei unklaren oder inkonsistenten Befunden ist eine Knochenbiopsie hilfreich. Der Artikel gibt einen aktuellen Überblick über die Möglichkeiten und Grenzen der oben genannten diagnostischen Verfahren.

Abstract

Physical examination, bone densitometry and x-ray are the mainstay in the evaluation of osteoporosis. A limited number of simple blood tests are sufficient to discriminate most secondary forms of osteoporosis and to exclude osteomalacia. Bone-specific biochemical markers play an increasing role in monitoring osteoporosis therapy. They may also play a role in treatment decision in the coming years. Bone biopsies are helpful if findings are unclear or inconsistent. The present review gives a summary of the opportunities and limitations of the above diagnostic procedures.

Schlüsselwörter

Osteoporose - Knochendichtemessung - Osteosonometrie - Knochenbiopsie - Biochemische Marker - Genetische Marker

Key words

Osteoporosis - Bone Densitometry - Osteosonometry - Bone Biopsy - Biochemical Markers - Genetic Markers

Literatur

• 1 Baran D T, Kelly A M, Karellas A. et al . Ultrasound of the os calcis in women with osteoporosis and hip fractures.  Calcif Tissue Int. 1988;  43 138-142
• 2 Kann P, Schulz U, Klaus D, Piepkorn B, Beyer J. In-vivo investigation of material quality of bone tissue by measuring apparent phalangeal ultrasound transmission velocity.  Clin Rheumatol. 1995;  14 26-34
• 3 Kann P. Basics of ultrasound methods for bone analysis. Schönau E Pediatric Osteology - New Developments in Diagnostics and Therapy Amsterdam; Elsevier 1996a: 161-167
• 4 Kann P, Scholz-Ahrens K, Schrezenmeir J, Beyer J. Investigation of bone hardness using a modified Vickers diamond method.  Exp Clin Endocrinol. 1996b;  104 57 (Suppl 1)
• 5 Pfeilschifter J. Jahresbericht der Sektion Calcium-Regulierende Hormone und Knochenstoffwechsel (CRHUKS).  Endokrinologie Informationen. 2000;  24 70-73
• 6 Melton I II LJ, Chrischilles E A, Cooper C, Lane A W, Riggs B L. How many women have osteoporosis?.  J Bone Miner Res. 1992;  7 1005-1010
• 7 Cummings S R, Black D M, Nevitt M C. et al . Bone density at various sites for predicting of hip fractures.  Lancet. 1993;  341 72-75
• 8 Hans D, Dargent-Molina P, Schott A M. et al . Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study.  Lancet. 1996;  348 511-514
• 9 Ettinger B, Block J E, Smith R. et al . An examination of the association between vertebral deformities, physical disabilities and psychosocial problems.  Maturitas. 1988;  10 238-296
• 10 Melton I I LJ, Kann S H, Frye M A, Wahner H W, O’Fallon W M, Riggs B L. Epidemiology of vertebral fractures in women.  Amer J Epidem. 1989;  129 1000-1011
• 11 Hansen M A, Overgaard K, Gotfredsen C. Does the prevalence of vertebral fractures increase?. Christiansen C, Overgaard K Osteoporosis 1990, Vol. 1 Kopenhagen; 1990: 95-97
• 12 Riis S BJ, Hansen A M, Jensen K, Overgaard K, Christiansen C. Low bone mass and fast rate of bone loss at menopause-equal risk factors for future fracture. A 15 year follow-up study.  Bone. 1996;  19 9-12
• 13 Sambrook P N, Jones G. Corticosteroid Osteoporosis.  Br J Rheumatol. 1995;  34 8-12
• 14 Storm T, Thamsborg G, Steiniche T, Genant H K, Sorensen O H. Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis.  New Engl J Med. 1990;  322 1265-1271
• 15 Liberman U A, Weiss S R, Bröll J. et al . Effect of oral alendronate on bone mineral density and the incidence of fracture in postmenopausal osteoporosis.  New Engl J Med. 1995;  333 1437-1443
• 16 Black D M, Cummings S R, Karpf D B. et al . Randomisedtrail of effect of a alendronate on risk of fracture in women with existing vertebral fractures.  Lancet. 1996;  348 1535-1541
• 17 Ettinger B, Black D M, Mitlak B H. et al . Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene.  JAMA. 1999;  282 637-645
• 18 Harris S T, Watts N B, Genant H K. et al . Ultrasaound velocity through bone predicts incident vertebral deformity.  J Bone Miner Res. 1995;  3 341-345
• 19 Reginster J -Y, Minne H W, Sorensen O H. et al . Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis.  Osteoporosis Int. 2000;  11 83-91
• 20 Riggs B L, Hodgson S F, O’Fallon W M, Chao E Y, Wahner H W, Muhs J M. Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis.  New Engl J Med. 1990;  322 802-809
• 21 Kleerekoper M, Mendlovic D B. Sodium fluoride therapy of postmenopausal osteoporosis.  Endocr Rev. 1993;  14 312-323
• 22 Porter R W, Miller C G, Grainger D, Palmer S B. Prediction of hip fracture in elderly women: a prospective study.  Br Med J. 1990;  301 638-641
• 23 Waud C E, Low R, Baran D T. The relationship between ultrasound and densitometric measurements of bone mass at the calcaneus in women.  Calcif Tissue Int. 1992;  51 415-418
• 24 Schott A M, Weill-Engerer S, Hans D, Duboeuf F, Delmas P D, Meunier P J. Ultrasound discriminates patients with hip fractures equaly well as dual energy x-ray absorptiometry and independently of bone mineral density.  L Bone Miner Res. 1995;  2 243-249
• 25 Wüster C, Albanese C, de Aloysio D. et al . Phalangeal osteosonogrammetry study: age-related changes, diagnostic sensitivity, and discrimination power.  J Bone Miner Res. 2000;  15 1603-1614
• 26 Eisman J A. Genetics of osteoporosis.  Endocrine Rev. 1999;  20 788-804
• 27 Kann P, Fang Y, Bergink A P. et al . The Collagen I ( 1 Sp1 Polymorphism is associated with differences in ultrasound transmission velocity in the calcaneus in postmenopausal women.  Calcif Tissue Int. in press
• 28 Riancho J A. Number of patients to be treated and number of prevented fractures: clinical efficiency of osteoporosis treatment with diphophonate alendronate.  Rev Clin Esp. 1999;  199 349-355
• 29 Thorsen K, Kristofferson A, Lorenzton R. The effects of brisk walking on markers of bone and calcium metabolism in postmenopausal women.  Calcif Tissue Int. 1996;  58 221-225
• 30 Ingle B M, Hay S M, Bottjer H M, Eastell R. Changes in bone mass and bone turnover following distal forearm fracture.  Osteoporosis Int. 1999;  10 399-407
• 31 Zerwekh J E, Ruml L A, Gottschalk F, Pak C Y. The effects of twelve weeks of bed rest on bone histology, biochemical markers of bone turnover, and calcium homeostasis in eleven normal subjects.  J Bone Miner Res. 1998;  13 1594-1601
• 32 Garnero P, Sornay-Rendu E, Chapuy M C, Delmas P D. Increased bone turnover in late postmenopausal women is a major determinant of osteoporosis.  J Bone Mineral Res. 1996;  11 337-349
• 33 Garnero P, Hausherr E, Chapuy M C. et al. Markers of bone resorption predict hip fracture in elderly women: The Epidos prospective study.  J Bone Miner Res. 1996;  11 1531-1538
• 34 Ross P D, Kress B C, Parson R E, Wasnich R D, Armour K A, Mizrahi I A. Serum bone alkaline phosphatase and calcaneus bone density predict fractures: A prospective study.  Osteoporos Int. 2000;  11 76-82
• 35 Calvo M S, Eyre D R, Gundberg C M. Molecular basis and clinical application of biological markers of bone turnover.  Endocrine Rev. 1996;  17 333-368
• 36 van Daele P LA, Seibel M J, Burger H. et al . Case-control analysis of bone resorption markers, disability, and hip fracture risk: The Rotterdam study.  Brit Med J. 1996;  312 482-483
• 37 Szulc P, Chapuy M C, Meunier P J, Delmas P D. Serum undercarboxylated osteocalcin is a marker of the risk of hip fracture in elderly women.  J Clin Invest. 1993;  91 1769-1774
• 38 Szulc P, Chapuy M C, Meunier P J, Delmas P D. Serum undercarboxylated osteoclacin is a marker of the riks of hip fracture: a three year follow-up study.  Bone. 1996;  5 487-488
• 39 Vergnaud P, Garnero P, Meunier P J, Breart G, Kamihagi K, Delmas P D. Undercarboxylated osteoclacin measured with a specific immunoassay predicts hip fracture in elderly women: the EPIDOS study.  J Clin Endocrinol Metab. 1997;  82 719-724
• 40 Keen R W, Nguyen T, Sobnack R, Perry L A, Thompson P W, Spector T D. Can biochemical markers predict bone loss at the hip and spine? a 4-year prospective study of 141 early postmenopausal women.  Osteoporosis Int. 1996;  6 399-406
• 41 Chestnut C H, Bell N H, Clark G S. et al . Hormone replacement therapy in postmenopausal women: urinary N-teopeptide of type I collagen monitors therapeutic effect and predicts response of bone mineral density.  Am J Med. 1997;  102 29-37
• 42 Ravn P, Clemmesen B, Christiansen C. Biochemical markers can predict the responses in bone mass during alendronate treatment in early postmenopausal women.  Bone. 1999;  24 237-244
• 43 Yoshimura N, Hashimoto T, Sakata K, Morioka S, Kasamatsu T, Cooper C. Biochemical markers of bone turnover and bone loss at the lumbar spine and femoral neck: the Taiji Study.  Calcif Tissue Int. 1999;  65 198-202
• 44 Chaki O, Yoshikata I, Kikuchi R. et al . The predictive value of biochemical markers of bone turnover for bone mineral density in postmenopausal Japanese women.  J Bone Miner Res. 2000;  15 1537-1544
• 45 Melton L J 3rd, Atkinson E J, O’Connor M K, O’Fallon W M, Riggs B L. Determinants of bone loss from the femoral neck in women of different ages.  J Bone Mineral Res. 2000;  15 24-31
• 46 Marcus R, Holloway L, Wells B. et al . The relationship of biochemical markers of bone turnover to bone density changes in postmenopausal women: results from the postmenopausal estrogen/progestin interventions (PEPI) trial.  J Bone Miner Res. 1999;  14 1583-1595
• 47 Scheidt-Nave C, Bismar H, Leidig-Bruckner G. et al . Serum interleukin 6 is a major predictor of bone loss in women specific to the first decade past menopause.  J Clin Endocrinol Metab. 2001;  86 2032-2042
• 48 Slemenda C, Longcope C, Peacock M, Hui S, Johnston C C. Sex steroids, bone mass, and bone loss. A prospective study of pre-, peri-, and postmenopausal women.  J Clin Invest. 1996;  97 14-21
• 49 Bauer D C, Sklarin P M, Stone K L. et al . Biochemical markers of bone turnover and prediction of hip bone loss in older women: the study of osteoporotic fractures.  J Bone Mineral Res. 1999;  14 1404-1410
• 50 Dennison E, Eastel R, Fall C HD. et al . Determinants of bone loss in elderly men and women: A prospective population-based study.  Osteoporos Int. 1999;  10 384-391
• 51 Eastell R, Delmas P D, Hodgson S F. et al . Bone formation rate in older normal women: concurrent assessment with bone histomorphometry, calcium kinetics, and biochemical markers.  J Clin Endocrinol Metab. 1988;  67 741-748
• 52 Garnero P, Sornay-Rendu E, Duboeuf F, Delmas P D. Markers of bone turnover predict postmenopausal forearm bone loss over 4 years: the OFELY study.  J Bone Mineral Res. 1999;  14 1614-1621
• 53 Johansen J S, Riis B J, Delmas P D, Christiansen C. Plasma BGP: an indicator of spontaneous bone loss and of the effect of oestrogen treatment in postmenopausal women.  Eur J Clin Invest. 1988;  18 191-195
• 54 Cooper C, Stakkesdad J A, Radowicki S. et al . Matrix delivery transdermal 17 B estradiol for the prevention of bone loss in postmenopausal women.  Osteoporosis Int. 1999;  9 358-366
• 55 Garnero P, Shih W J, Gineyts E, Karpf D, Delmas P D. Comparison of new biochemical markers of bone turnover in late postmenopausal women in response to alendronate treatment.  J Clin Endocrinol Metab. 1994;  79 1693-1700
• 56 Greenspan S L, Rosen H N, Parker R A. Early changes in serum N-telopeptide and C-telopeptide cross-linked collagen type 1 predict long-term response to alendronate therapy in elderly women.  J Clin Endocrinol Metab. 2000;  85 3537-3540
• 57 Delmas P D, Bjarnasson N H, Mitlak B H. et al . Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women.  New Eng J Med. 1997;  337 1641-1647
• 58 Heikkinen A -M, Parviainen M, Niskanen L. et al . Biochemical bone markers and bone mineral density during postmenopausal hormone replacement therapy with and without vitamin D3: a prospective, controlled, randomized study.  J Clin Endocrinol Metab. 1997;  82 2476-2482
• 59 Rosen C J, Chesnut I II CH, Mallinak N JS. The predictive value of biochemical markers of bone turnover for bone mineral density in early postmenopausal women treated with hormone replacement or calcium supplementation.  J Clin Endocrinol Metab. 1997;  82 1904-1910
• 60 Ravn P, Christensen J O, Baumann M, Clemmesen B. Changes in biochemical markers and bone mass after withdrawal of ibandronate treatment: prediction of bone mass changes during treatment.  Bone. 1998;  22 559-564
• 61 Ravn P, Hosking D, Thompson G C. et al . Monitoring of alendronate treatment and prediction of effect on bone mass by biochemical markers in early postmenopausal intervention cohort of study.  J Clin Endocrinol Metab. 1999;  84 2363-2368
• 62 Garnero P, Darte C, Delmas P D. A model to monitor the efficacy of alendronate treatment in women with osteoporosis using a biochemical markers of bone turnover.  Bone. 1999;  24 603-609
• 63 Bjarnason N H, Christiansen C, Sarkar S. et al . 6 months changes in biochemical markers predict 3-year response in vertebral fracture rate in postmenopausal, osteoporotic women: results from the MORE study.  J Bone Miner Res. 1999;  14 S157 (S1)
• 64 Seck T, Scheidt-Nave C, Leidig-Bruckner G, Ziegler R, Pfeilschifter J. Low serum concentrations of insulin-like growth factor I are associated with femoral bone loss in a population-based sample of postmenopausal women.  Clin Endocrinol. 2001;  55 101-106
• 65 Garnero P, Sornay-Rendu E, Delmas P D. Low serum IGF-1 and occurence of osteoporotic fractures in postmenopausal women.  Lancet. 2000;  355 898-899
• 66 Stone K, Bauer D C, Black D M, Sklarin P, Ensrud K E, Cummings S R. Hormonal predictors of bone loss in elderly owmen: a prospective study.  J Bone Miner Res. 1998;  13 1167-1174
• 67 Garnero P, Sornay-Rendu E, Claustrat B, Delmas P D. Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: the OFELY Study.  J Bone Miner Res. 2000;  15 1526-1536
• 68 Hobson E E, Ralston S H. Role of genetic factors in the pathophysiology and management of osteoporosis.  Clin Endocrinol. 2001;  54 1-9
• 69 Hinke V, Seck T, Clanget C, Scheidt-Nave C, Ziegler R, Pfeilschifter J. Association of transforming growth factor-ß1 (TGF-ß1) T29(C gene polymorphism with bone mineral density (BMD), changes in BMD, and serum concentrations of TGF-ß1 in a population-based sample of postmenopausal German women.  Calcif Tissue Int. in Druck