Arteriosklerose und Knochendichte – Arterielle Kalzifikationen in der hochauflösenden, peripheren quantitativen Computertomographie

Zusammenfassung

Aufgrund der Gemeinsamkeit eines mineralisierten Gewebes sowohl im Falle des Knochens (mineralisiertes Osteoid) als auch bei Arteriosklerose (Mineralisation im Bereich des Endothels bei chronischer Entzündungsreaktion) und verwandter biochemischer Mechanismen wird seit geraumer Zeit ein Zusammenhang zwischen Arteriosklerose und der Knochenstruktur und -mineralisation vermutet. Eine abnehmende Knochendichte in der Knochendichtemessung (DXA) konnte parallel zu einem gehäuften Auftreten einer Arteriosklerose gezeigt werden, eine Kausalität konnte bis heute nicht geklärt werden. Die hochauflösende, periphere, quantitative Computertomographie (HR-pQCT) bietet die Möglichkeit die Kalzifikation der Arterien der unteren Extremität im Scanvolumen zu detektieren und quantifizieren. Hierbei treten Gefäßkalzifikationen nebenbefundlich in Abhängigkeit der Grunderkrankung bei 32,6% der Patienten ohne Grunderkrankung auf. Bei weiblichen Patient:innen ohne Grunderkrankung konnte im Gegensatz zu Männern eine gleichzeitige Abnahme einzelner kortikaler und trabekulärer HR-pQCT-Parameter bei vermehrtem Auftreten einer LLAC beobachtet werden. Bei einer CKD lässt sich parallel zum vermehrten Auftreten einer LLAC ein kortikales Knochenstrukturverlustsyndrom feststellen, wobei CKD-Patienten mit LLAC signifikant geminderte Werte im Vergleich zu CKD-Patienten ohne LLAC aufwiesen. Auch beim Hypoparathyreoidismus zeigen sich eine Häufung der LLAC im HR-pQCT im Vergleich zu einer Kontrollgruppe. Somit zeigt sich der Einfluss einer Dysbalance der Calciumhomöostase auf die Mineralisation beider Gewebe und unterstreicht die hohe Bedeutung einer Balancierung der Calciumhomöostase. Dieser Artikel stellt die bisherigen Erkenntnisse und Zusammenhänge der Arteriosklerose mit osteologischen Aspekten im Sinne der Knochenmikrostruktur und weiterer Parameter vor.

Abstract

Due to the commonality of a mineralized tissue both in the case of bone (mineralized osteoid) and atherosclerosis (mineralization in the area of the endothelium during chronic inflammatory) and related biochemical mechanisms, a connection between atherosclerosis and bone structure and mineralization has been suspected for some time. Decreasing bone density has been shown to occur parallel to a occurrence of atherosclerosis. High-resolution peripheral quantitative computed tomography (HR-pQCT) offers the opportunity to detect and quantify the calcification of the lower leg arteries within the scan volume. Calcifications of the lower leg arteries (LLAC) occur in 32.6% of patients without underlying disease. In female patients without underlying disease, in contrast to men, a concomitant decrease in specific cortical and trabecular HR-pQCT parameters was observed with an increased occurrence of LLAC. In CKD, a cortical bone loss can be observed simultaneously with the occurrence of LLAC, with CKD patients with LLAC showing significantly reduced values compared to CKD patients without LLAC. Hypoparathyroidism also shows an accumulation of LLAC in HR-pQCT compared to a control group. Therefore, the influence of a disbalance of the calcium homeostasis on the mineralization of both tissues becomes apparent. This article presents the previous findings and correlations of atherosclerosis with osteological aspects in terms of bone microstructure and other parameters.

Schlüsselwörter

Knochenmikrostruktur - Knochendichte - Arteriosklerose - HR-pQCT - Gefäßkalzifikation

Key words

bone microstructure - bone density - atherosclerosis - HR-pQCT - vascular calcification

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