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Osteologie 2017; 26(02): 87-92
DOI: 10.1055/s-0037-1622090
Knochenmarködemsyndrom
Schattauer GmbH

Das Knochenmarködemsyndrom-Register

Ein Weg zur evidenzbasierten Therapie?Bone marrow edema syndromeWays to an evidence-based treatment
T. Randau
1   Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinik Bonn, Bonn
,
A. Roth
2   Klinik für Orthopädie, Unfall-chirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig
,
U. Maus
3   Pius-Hospital Oldenburg, Universitätsklinik für Orthopädie und Unfallchirurgie Oldenburg, Oldenburg
,
K. M. Peters
4   Orthopädie, Dr. Becker Rhein-Sieg-Klinik, Nümbrecht
› Author Affiliations
Further Information

Publication History

eingereicht: 08 May 2017

angenommen: 10 May 2017

Publication Date:
02 January 2018 (online)

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Zusammenfassung

Unter dem Begriff des Knochenmarködemsyndroms (KMÖS) subsumieren sich verschiedene Krankheitsbilder unterschiedlicher Ätiologie. Entsprechend dem Erscheinungsbild, den vorliegenden Risikofaktoren und den Begleitumständen wird die Erkrankung oft als Beginn einer Osteonekrose, als transiente Osteoporose oder als Begleitreaktion auf andere Knochenerkrankungen interpretiert. Auch als Folge eines traumatischen Geschehens (“bone bruise”) oder einer mechanischen Überlastung (“Stressfraktur”) wird häufig ein Knochenmarködem als MRT-Korrelat gesehen. Gemeinsam ist allen Formen der Knochenschmerz als Leitsymptom, der oft über Wochen oder Monate bestehen bleiben kann und den betroffenen Patienten relevant einschränkt. Entsprechend vielfältig sind die angebotenen und praktizierten Therapiemöglichkeiten. Neben verschiedenen konservativen Verfahren steht die medikamentöse The-rapie im Mittelpunkt, die aus Mangel an anderen Alternativen fast regelhaft als Offla-bel-Anwendung erfolgt. Allen Therapieformen gemein ist dabei ein Mangel an belastbarer Evidenz für oder gegen die praktizierten Konzepte. Vorbereitend zur Verbesserung der Evidenzlage mittels entsprechender Studien und gegebenenfalls langfristig der Entwicklung von Standards oder einer Leitlinie zur Behandlung dieses heterogenen Krankheitsbildes ist zunächst eine Bestandsaufnahme der aktuellen Situation im deutschsprachigen Raum sinnvoll. Mit einem Fallregister, initiiert von der DGOU und dem BVOU, soll die praktisch vorhandene Erfahrung in der Therapie des Knochenmarködemsyndroms gesammelt und gebündelt werden, um aus diesen Daten zukünftig eine valide Behandlungsempfehlung erstellen zu können. Der vorliegende Artikel beschreibt das Konzept und die Rationale dieses Registers und fasst die bisher vorhandene Evidenz kurz zusammen.

Summary

The term “bone marrow edema syndrome” (BMES) combines a variety of diseases of very different etiology. Depending on the onset and clinical presentation and associated risk factors or comorbidities, the disease is classified as an early form of osteonecrosis or a local transient osteoporosis, and can also accompany other bone and joint conditions. As “bone bruise”, the lesions appear after trauma or after repetitive or excessive mechanical strain as insufficiency fractures. A bone marrow edema is seen on the MRI in correlation with the pain, which is the leading symptom and can last for weeks or month. As diverse as the presentation of the disease are the possible treatment options. While therapy concepts vary widely, they all have in common a lack in sufficient evidence for their efficiency. Next to conservative care options, medication therapy is often applied. Due to a lack of alternatives, the off-label use is then common practice. Ultimately, we aim to enhance the level of evidence for the treatment of bone marrow edema syndrome by employing sensible prospective and randomized studies, and to compose a treatment guideline, based on the results of such trials. In preparation towards this final goal it seems necessary to first assess the current status quo in treatment regimens among the germanspeaking physicians. The German Society of Orthopedics and Trauma (DGOU), as well as the Professional Association of Orthopedics and Trauma (BVOU) initiated a case-based register to gather and record all expertise and experience that is currently present, regarding the diagnostics, the treatment and outcome of bone marrow edema syndrome. Based on this data pool, future studies could be planned and initiated, and treatment guidelines be devised. This article describes the concept and rationale of the register, and summarizes the evidence already present.

Schlüsselwörter

“Bone bruise” - lokale transiente Osteoporose - evidenzbasierte Medizin - Registerstudie

Keywords

“Bone bruise” - local transient osteoporosis - register study - evidence based medicine
 

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