RSS-Feed abonnieren
DOI: 10.1055/a-1206-6747
Das Knochenmarködem-Syndrom: interdisziplinäre Diagnosestrategie und Therapieoptionen
Bone marrow edema syndrome: interdisciplinary diagnostic strategy and treatment options![](https://www.thieme-connect.de/media/10.1055-s-00034914/202101/lookinside/thumbnails/10.1055a-1206-6747-1.jpg)
Zusammenfassung
Das Knochenmarködem (KMÖ) ist ein häufiger, rein deskriptiver Befund in der Magnetresonanztomographie (MRT). Schmerz ist das klinische Hauptsymptom. Knochenmarködeme unterscheiden sich wesentlich in Ursache, zugrundeliegender Erkrankung sowie in Therapie, Verlauf und Prognose. Diese Komplexität macht, zusammen mit dem Fehlen evidenzbasierter Leitlinien, die Identifizierung der Ursachen und deren Therapie zu einer großen Herausforderung. Ein interdisziplinärer Arbeitskreis des osteologischen Schwerpunktzentrums des LMU Klinikums hat ein KMÖ-Konsensuspapier erbarbeitet und publiziert [4]. Hier sollen die Ergebnisse mit einem Schwerpunkt auf das schmerzhafte KMÖ-Syndrom (KMÖS) präsentiert werden. In unserer klinischen Erfahrung kommt es zu deutlichen Verzögerungen bei Diagnose sowie Therapie, deshalb besteht nach wie vor die Notwendigkeit von interdisziplinären klinischen Empfehlungen. In der hier vorliegenden Arbeit ist nun eine Überarbeitung des Konsensuspapiers [4] mit Fokus auf dem Aspekt des schmerzhaften Knochenmarködem-Syndroms erfolgt. Aus erneuter Literaturrecherche, Überprüfung klinischer Erfahrungen (Expertenmeinung) und der ergebnisorientierten Überarbeitung des LMU-Konsenuspapiers wurde eine Zusammenfassung mit diagnostischen Maßnahmen, Differenzialdiagnosen und Therapieoptionen beim KMÖS erstellt. Ziel ist eine stratifizierte, klinische Herangehensweise hinsichtlich weiterführender Diagnostik und auch Therapie bei Vorliegen eines schmerzhaften KMÖS.
Abstract
Bone marrow edema (BME) is a common, purely descriptive finding in magnetic resonance imaging (MRI). Pain is the main clinical symptom. BME differs significantly in terms of cause, underlying disease, as well as therapy, course and prognosis. This complexity, together with the lack of evidence-based guidelines, makes identifying the causes and treating them a major challenge. The interdisciplinary working group of our Comprehensive Osteological Center DVO of the LMU has already developed a consensus paper on the BME and published it in English in detail [4]. If no underlying disease of the BME can be identified the term painful BME syndrome (BMES) should be used. In our clinical experience there are significant delays in diagnosis and therapy, which is why there is still a need for interdisciplinary clinical recommendations. In the present work, the consensus paper [4] has been revised with a focus on the painful bone marrow edema syndrome (BMES). A summary with diagnostic measures, differential diagnoses and therapy options in BMES was created from a renewed literature research, review of clinical experience (expert opinion) and the results-oriented revision of the LMU consensus paper. The aim is a stratified, clinical approach with regard to further diagnostics and also therapy in the presence of painful BMES. We expressly point out that this is a revised part of a work that has already been published in English.
Schlüsselwörter
interdisziplinärer Konsens - Algorithmus - Diagnose - Therapie - Knochenmarködem-Syndrom - KnochenmarködemKey words
interdisciplinary consensus - algorithm - diagnosis - therapy - bone marrow edema - bone marrow edema syndromePublikationsverlauf
Artikel online veröffentlicht:
05. März 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Aigner N, Petje G, Steinboeck G. et al. Treatment of bone-marrow oedema of the talus with the prostacyclin analogue iloprost an MRI-controlled investigation of a new method. Bone Joint Surg Br. 2001; 83: 855-8 . DOI: doi: 10.1302/0301-620x.83b6.
- 2 Mirghasemi SA, Trepman E, Sadeghi MS. et al. Bone marrow edema syndrome in the foot and ankle. Foot Ankle Int 2016; 37: 1364-1373
- 3 Singh D, Ferrero A, Rose B. et al. Bone marrow edema syndrome of the foot and ankle: Mid- to long-term follow-up in 18 patients. Foot Ankle Spec 2016; 9: 218-226
- 4 Baumbach SF, Pfahler V, Bechtold-Dalla Pozza S. et al. How we manage bone marrow edema – an interdisciplinary approach. J Clin Med 2020; 9: 551
- 5 Patel S. Primary bone marrow oedema syndromes. Rheumatol (United Kingdom) 2014; 53: 785-792
- 6 Krause R, Glas K, Schulz A. et al. Das transitorische Knochenmarködemsyndrom der Hüfte The Transitory Bone Marrow Edema Syndrom of the Hip Institutsangaben 1 Orthopädische Klinik im Klinikum Passau.
- 7 Gaeta M, Mazziotti S, Minutoli F. et al. Migrating transient bone marrow edema syndrome of the knee: MRI findings in a new case. Eur Radiol 2002; 12: S40-S42
- 8 Geiker NRW, Mølgaard C, Iuliano S. et al. Impact of whole dairy matrix on musculoskeletal health and aging – current knowledge and research gaps. Osteoporos Int 2020; 31: 601-615
- 9 KALMBA KA. Transient Osteoporosis. J Am Acad Orthop Surg 2008; 6: 480-488
- 10 Shabestari M, Vik J, Reseland JE. et al. Bone marrow lesions in hip osteoarthritis are characterized by increased bone turnover and enhanced angiogenesis. Osteoarthr Cartil 2016; 24: 1745-1752
- 11 Manara M, Varenna M, Manara M. et al. A clinical overview of bone marrow edema. Reumatismo 2014; Jul 28;. 66 (02) : 184-196.
- 12 Appel H, Loddenkemper C, Grozdanovic Z. et al. Correlation of histopathological findings and magnetic resonance imaging in the spine of patients with ankylosing spondylitis. Arthritis Res Ther 2006; 8 (05) : R143
- 13 Taljanovic MS, Graham AR, Benjamin JB. et al. Bone marrow edema pattern in advanced hip osteoarthritis: Quantitative assessment with magnetic resonance imaging and correlation with clinical examination, radiographic findings, and histopathology. Skeletal Radiol 2008; 37: 423-431
- 14 Thiryayi WA, Thiryayi SA, Freemont AJ. Histopathological perspective on bone marrow oedema, reactive bone change and haemorrhage. Eur J Radiol 2008; 67: 62-67
- 15 Karantanas AH. Acute bone marrow edema of the hip: Role of MR imaging. Eur Radiol 2007; 17: 2225-2236
- 16 Ghasemi RA, Sadeghi S, Rahimee N. et al. Technologies in the treatment of bone marrow edema syndrome. Orthop Clin North Am 2019; 50: 131-138
- 17 Fernandez-Canton G, Casado O, Capelastegui A. et al. Bone marrow edema syndrome of the foot: One year follow-up with MR imaging. Skeletal Radiol 2003; 32: 273-278
- 18 Sprinchorn AE, O’Sullivan R, Beischer AD. Transient bone marrow edema of the foot and ankle and its association with reduced systemic bone mineral density. Foot Ankle Int 2011; 32: 508-512
- 19 Orr JD, Sabesan V, Major N. et al. Painful bone marrow edema syndrome of the foot and ankle. Foot Ankle Int 2010; 31: 949-953
- 20 Poggiogalle E, Cherry KE, Su LJ. et al. Body composition, IGF1 status, and physical functionality in nonagenarians: Implications for osteosarcopenia. J Am Med Dir Assoc 2019; 20 (70-75): e2
- 21 Geith T, Niethammer T, Milz S. et al. Transient bone marrow edema syndrome versus osteonecrosis: Perfusion patterns at dynamic contrast-enhanced MR imaging with high temporal resolution can allow differentiation. Radiol 2017; 283: 478-485
- 22 Beaudart C, Rolland Y, Cruz-Jentoft AJ. et al. Assessment of muscle function and physical performance in daily clinical practice: A position paper endorsed by the European society for clinical and economic aspects of osteoporosis, osteoarthritis and musculoskeletal diseases (ESCEO). Calcif Tissue Int 2019; 105 (01) : 1-14
- 23 Löffler MT, Sollmann N, Mei K. et al. X-ray-based quantitative osteoporosis imaging at the spine. Osteoporos Int 2020; 31: 233-250
- 24 Ringe JD, Dorst A, Faber H. Effective and rapid treatment of painful localized transient osteoporosis (bone marrow edema) with intravenous ibandronate. Osteoporos Int 2005; 16: 2063-2068
- 25 Nakamura H, Masuko K, Yudoh K. et al. Positron emission tomography with 18F-FDG in osteoarthritic knee. Osteoarthr Cartil 2007; 15: 673-681
- 26 Plenk H, Hofmann S, Eschberger J. et al. Histomorphology and bone morphometry of the bone marrow edema syndrome of the hip. Clin Orthop Relat Res 1997; 334: 73-84
- 27 Meizer R, Radda C, Stolz G. et al. MRI-controlled analysis of 104 patients with painful bone marrow edema in different joint localizations treated with the prostacyclin analogue iloprost. Wien Klin Wochenschr 2005; 117: 278-286
- 28 Beckmann J, Roth A, Niethard C. et al. Knochenmarködem und atraumatische Femurkopfnekrose: Therapie. Orthopäde 2015; 44: 662-671
- 29 Ito M, Nakayama K, Konaka A. et al. Effects of a prostaglandin EP4 agonist, ONO-4819, and risedronate on trabecular microstructure and bone strength in mature ovariectomized rats. Bone 2006; 39: 453-459
- 30 Kubo T, Yamazoe S, Sugano N. et al. Initial MRI findings of non-traumatic osteonecrosis of the femoral head in renal allograft recipients. Magn Reson Imaging 1997; 15 (09) : 1017-1023
- 31 Koch E, Gregorio Sialer H, Marincek B. et al. Failure of MR imaging to detect reflex sympathetic dystrophy of the extremities. AJR Am J Roentgenol 1991; Jan;. 156 (01) : 113-115
- 32 Hwang S, Lefkowitz R, Landa J. et al. Local changes in bone marrow at MRI after treatment of extremity soft tissue sarcoma. Skeletal Radiol 2009; 38: 11-19
- 33 Vande Berg BC, Malghem J, Devuyst O. et al. Anorexia nervosa: Correlation between MR appearance of bone marrow and severity of disease. Radiol 1994; Dec;. 193 (03) : 859-864
- 34 Breitenstein A, Stumpe KDM, Gnannt R. et al. Calcineurin inhibitor-induced pain syndrome after kidney transplantation-a rare but disabling condition. NDT Plus 2011; 4: 63-66
- 35 Nardo L, Sandman DN, Virayavanich W. et al. Bone marrow changes related to disuse. Eur Radiol 2013; 23: 3422-3431
- 36 Dachverband Osteologie e.V. (DVO).. Entwurf für DVO-Leitlinien zur Therapie der Osteoporose (06.03.2009). Im Internet: www.dv-osteologie.de;. Stand: 09.03.2009. Prophylaxe, Diagnostik und Therapie der OSTEOPOROSE bei postmenopausalen Frauen. Im Internet: http://www.dv-osteologie.org
- 37 Horas K, Fraissler L, Maier G. et al. High prevalence of vitamin D deficiency in patients with bone marrow edema syndrome of the foot and ankle. Foot Ankle Int 2017; 38: 760-766
- 38 Tezcan ME, Temizkan S, Ozal ST. et al. Evaluation of acute and chronic MRI features of sacroiliitis in asymptomatic primary hyperparathyroid patients. Clin Rheumatol 2016; 35: 2777-2782
- 39 Hadji P, Boekhoff J, Hahn M. et al. Pregnancy-associated transient osteoporosis of the hip: Results of a case-control study. Arch Osteoporos 2017; Dec;. 12 (01) : 11
- 40 Hadji P, Boekhoff J, Hahn M. et al. Pregnancy-associated osteoporosis: A case-control study. Osteoporos Int 2017; 28: 1393-1399
- 41 Hardcastle SA, Yahya F, Bhalla AK. Pregnancy-associated osteoporosis: A UK case series and literature review. Osteoporos Int 2019; 30: 939-948
- 42 Flores-Robles BJ, Sanz-Sanz J, Sanabria-Sanchinel AA. et al. Zoledronic acid treatment in primary bone marrow edema syndrome. J Pain Palliat Care Pharmacother 2017; 31: 52-56
- 43 Vitali M, Naim Rodriguez N, Pedretti A. et al. Bone marrow edema syndrome of the medial femoral condyle treated with extracorporeal shock wave therapy: A clinical and MRI retrospective comparative study. Arch Phys Med Rehabil 2018; 99: 873-879
- 44 Gigena LM, Chung CB, Lektrakul N. et al. Transient bone marrow edema of the talus: MR imaging findings in five patients. Skeletal Radiol 2002; 31: 202-207
- 45 Hofmann S, Kramer J, Vakil-Adli A. et al. Painful bone marrow edema of the knee: Differential diagnosis and therapeutic concepts. Orthop Clin North Am 2004; 35: 321-333
- 46 Hörterer H, Baumbach SF, Gregersen J. et al. Treatment of bone marrow edema of the foot and ankle with the prostacyclin analog iloprost. Foot Ankle Int 2018; 39: 1183-1191
- 47 Röhner E, Zippelius T, Steindl D. et al. Effects of intravenous iloprost therapy in patients with bone marrow oedema of the foot and ankle. Eur J Orthop Surg Traumatol 2014; 24: 1609-1616
- 48 Mayerhoefer ME, Kramer J, Breitenseher MJ. et al. Short-term outcome of painful bone marrow oedema of the knee following oral treatment with iloprost or tramadol: Results of an exploratory phase II study of 41 patients. Rheumatology 2007; 46: 1460-1465
- 49 Baier C, Schaumburger J, Götz J. et al. Bisphosphonates or prostacyclin in the treatment of bone-marrow oedema syndrome of the knee and foot. Rheumatol Int 2013; 33: 1397-1402
- 50 Berger CE, Kröner AH, Kristen KH. et al. Transient bone marrow edema syndrome of the knee: Clinical and magnetic resonance imaging results at 5 years after core decompression. Arthrosc – J Arthrosc Relat Surg 2006; 22: 866-871