Laboruntersuchungen bei metabolischen Osteopathien

Zusammenfassung

Bei Verdacht auf metabolische Knochenerkrankungen werden leitliniengerecht die Parameter des sogenannten Basislabors zur Screening-Diagnostik eingesetzt. Die Aktivität der alkalischen Phosphatase (AP) und die Serum-Spiegel für Kalzium und Phosphat geben erste Informationen zum Knochenstoffwechsel. Auffällige Parameter im Basislabor und die klinische Problemstellung, beurteilt durch einen erfahrenen Spezialisten in osteologischen Zentren sind die Eingangskriterien für eine erweiterte Diagnostik. Klassische Konstellationen sind die isoliert erhöhte oder erniedrigte AP bei Morbus Paget und Hypophosphatasie, der sekundäre Hyperparathyreoidismus bei Rachitis/Osteomalazie, und Phosphatverlust-Syndrome mit inadäquat niedrigem Parathormon und Vitamin-D-Hormon. Die Untersuchung der Kalzium- und Phosphat-Bilanz und von FGF23 ermöglicht die Differenzialdiagnose der Rachitis und Osteomalazie. Die genannten Parameter erlauben eine breite und sichere Differenzialdiagnose, spezielle Parameter sind nur selten notwendig. Verlaufsuntersuchungen bei chronischen Erkrankungen sind oft mit einzelnen Markern in größeren Abständen zuverlässig.

Summary

Laboratory testing of metabolic bone disease is initiated using a screening panel of clinical chemistry parameters according to osteoporosis guidelines, comprising measurements of alkaline phosphatase (AP) and of serum levels for calcium and inorganic phosphate, to get basic information about bone metabolism. Based on these results and on the clinical query the expansion of laboratory testing using specific bone markers and hormone levels is evaluated by a specialist for metabolic bone disease and osteology.The classical constellations found are e.g. elevated or low AP activity levels in Paget´s disease of bone or hypophosphatasia respectively, secondary hyperparathyroidism in rickets and osteomalacia and phosphate wasting syndromes showing inadequately low levels of parathyroid hormone and vitamin D-hormone. Measuring the balance of calcium and phosphate metabolism and serum FGF23 levels allows for differential diagnosis of rickets and osteomalacia. Using these parameters a broad differential diagnosis can be covered and only rarely is there a need for further expansion of special bone marker measurement. Follow-up tests in chronic diseases can often be reliably done using single bone markers or a reduced panel of the above.

Schlüsselwörter

Osteomalazie - Hypophosphatasie - Morbus Paget - Knochenmarker

Keywords

Osteomalacia - hypophosphatasia - Paget´s disease - bone marker

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