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Osteologie 2015; 24(02): 85-91
DOI: 10.1055/s-0037-1622053
Querschnittlähmung und Osteoporose
Schattauer GmbH

Querschnittassoziierte Osteoporose

Der Leitlinienentwurf der Arbeitsgruppe Osteoporose der Deutschsprachigen Medizinischen Gesellschaft für Paraplegie (DMGP) als DiskussionsgrundlageSpinal Cord Injury related osteoporosisThe draft of the working group for Osteoprosis of the German-speaking Medical Society of Paraplegia (DMGP) as a basis for discussion
A. Frotzler
1   Clinical Trial Unit, Schweizer Paraplegiker-Zentrum Nottwil, Schweiz
,
J. Moosburger
2   Rehaklinik Olgabad, Bad Wildbad, Deutschland
,
Y.-B. Kalke
3   RKU – Universitäts- und Rehabilitationsklinken Ulm, Querschnittgelähmtenzentrum, Orthopädische Universitätsklinik, Ulm, Deutschland
› Author Affiliations
Further Information

Publication History

eingereicht: 24 March 2015

angenommen: 30 March 2015

Publication Date:
02 January 2018 (online)

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Zusammenfassung

Als Diskussionsgrundlage liegt der Entwurf einer S1-Leitlinie zur querschnittassoziierten Osteoporose der Arbeitsgruppe Osteoporose der DMGP vor. Der Entwurf wurde u. a. in Anlehnung an die DVO-Leitlinie “Prophylaxe, Diagnostik und Therapie der Osteoporose bei Männern ab dem 60. Lebensjahr und bei postmenopausalen Frauen” erarbeitet. Die Ursache der querschnittassoziierten Osteo -porose ist multifaktoriell, die fehlende mechanische Belastung gilt als ein Hauptfaktor. Der Verlust an Knochenmineraldichte kann bereits innerhalb der ersten Monate nach Rückenmarksverletzung gemessen werden. Osteoporotisch bedingte Frakturen durch inadäquate Traumata treten bei Querschnitt -gelähmten häufig im Bereich des distalen Femurs und der proximalen Tibia auf. Es gibt nur wenige Berichte mit hoher Evidenz zur Prävention oder Therapie einer querschnitt-assoziierten Osteoporose sowie keine Hinweise darauf, inwieweit die Frakturinzidenz tatsächlich beeinflusst werden kann. Bisphosphonate scheinen die Knochenresorption bei Rückenmarksverletzten zu reduzieren. Auch gibt es Hinweise dafür, dass Funktionelle Elektrostimulation (FES) – unter gewissen Voraussetzungen – einen osteogenen Effekt auf die Knochenparameter der gelähmten Extremität besitzt. Eine DXA-Messung an LWS und einer Hüfte sollte innerhalb von sechs bis acht Wochen nach Eintritt der Querschnittlähmung erfolgen, entsprechende Kontrolluntersuchungen nach festgelegten Intervallen einseitig im Hüftbereich. Die Grundmedikation mit Kalzium und Vitamin D wird bei einem T-Score zwischen –1,0 und –2,0 empfohlen, ab –2,0 und darunter zusätzlich die Gabe von Antiresorptiva/ Osteo anabolika. Eine Therapiedauer von mindestens fünf Jahren wird für indiziert gehalten, solange der T-Score –2,0 oder geringer ist.

Summary

The S1-guideline “Spinal Cord Injury related osteoporosis” was worked out as draft by the osteoporosis workgroup of the German-speaking Medical Society of Paraplegia (DMGP). The recommendations are based on the DVO-guideline “Prevention, diagnostics and therapy of osteoporosis in men over 60 and in postmenopausal women” (Guideline 2006, revised version 2014). There are multiple reasons for spinal cord injury (SCI) related osteoporosis additional to the pure mechanical relief. The loss of bone mineral density can be measured within the first months after SCI. Osteoporosis related fractures can be found typically in the region of the distal femur and the proximal tibia without adequate trauma. So far there are not high level evidenced based recommendations for prevention and therapy of osteoporosis in individuals with SCI to minimize the risk of fracture incidence. Bisphosphonates seem to reduce the bone resorption and functional electrical stimulation seems to have a positive influence on the bone density in this special patient group. Osteodensitometry with DXA for lumbar spine and hip region should be performed within six to eight weeks after SCI, further control examinations in a scheduled time frame only on one hip side. Basic medication with calcium and vitamin D3 will be recommended for a t-score between –1.0 and –2.0, additional use of bisphosphonates or osteoanabolic medication for a t-score of < –2.0. This therapy should be given for the duration of at least five years as long as the t-score is < –2.0.

Schlüsselwörter

Querschnittlähmung - Osteoporose - Elektro -stimulation - Bisphosphonate

Keywords

Spinal cord injury - osteoporosis - functional electrical stimulation - bisphosphonates
 

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