Wirbelkörperfrakturen bei Osteoporose

Zusammenfassung

Osteoporotische Frakturen der Wirbelsäule stellen eine zunehmende Herausforderung dar. Heute verfügbare Klassifikationssysteme helfen zusammen mit Scores, welche die individuellen Gegebenheiten der Betroffenen berücksichtigen, das therapeutische Vorgehen individuell anzupassen. In diesem Beitrag werden Hinweise zur diagnostischen Vorgehensweise, den konservativen und operativen Therapiemöglichkeiten und zu den Besonderheiten von Wirbelfrakturen bei Osteoporose gegeben.

Abstract

Osteoporotic fractures of the spine represent an increasing challenge. Classification systems available today, together with scores that take into account the individual circumstances of the affected patients, help to personalize the therapeutic approach. The following article provides information on the diagnostic procedure, conservative and surgical treatment options and the special features of osteoporotic vertebral fractures.

Schlüsselwörter

Osteoporotische Wirbelfraktur - Diagnostik - konservative Therapie - operative Therapie

Keywords

Osteoporotic vertebral fracture - diagnosis - conservative treatment - surgical treatment

Publikationsverlauf

Eingereicht: 14. Mai 2024

Angenommen: 11. Juli 2024

Artikel online veröffentlicht:
22. August 2024

• Literatur

• 1 Kendler DL, Bauer DC, Davison KS. et al. Vertebral Fractures: Clinical Importance and Management. Am J Med 2016; 129: 221.e1-10
• 2 Somma T, Rosa de A, Mastantuoni C. et al. Multidisciplinary management of osteoporotic vertebral fractures. Minerva Endocrinol (Torino) 2022; 47: 189-202
• 3 Jang H-D, Kim E-H, Lee JC. et al. Management of Osteoporotic Vertebral Fracture: Review Update 2022. Asian. Spine J 2022; 16: 934-946
• 4 Bliuc D, Center JR. Determinants of mortality risk following osteoporotic fractures. Curr Opin Rheumatol 2016; 28: 413-419
• 5 Capdevila-Reniu A, Navarro-López M, López-Soto A. Osteoporotic vertebral fractures: A diagnostic challenge in the 21^st century. Rev Clin Esp (Barc) 2021; 221: 118-124
• 6 Costa AG, Wyman A, Siris ES. et al. When, where and how osteoporosis-associated fractures occur: an analysis from the Global Longitudinal Study of Osteoporosis in Women (GLOW). PLoS One 2013; 8: e83306
• 7 Lippuner K, Johansson H, Kanis JA. et al. Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women. Osteoporos Int 2009; 20: 1131-1140
• 8 Robinson WA, Carlson BC, Poppendeck H. et al. Osteoporosis-related Vertebral Fragility Fractures: A Review and Analysis of the American Orthopaedic Association’s Own the Bone Database. Spine (Phila Pa 1976) 2020; 45: E430-E438
• 9 Genant HK, Wu CY, van Kuijk C. et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993; 8: 1137-1148
• 10 Schnake KJ, Bula P, Spiegl UJ. et al. Thorakolumbale Wirbelsäulenfrakturen beim alten Menschen: Klassifikation und Therapie. Unfallchirurg 2017; 120: 1071-1085
• 11 Schnake KJ, Blattert TR, Hahn P. et al. Classification of Osteoporotic Thoracolumbar Spine Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 2018; 8: 46S-49S
• 12 Blattert TR, Schnake KJ, Gonschorek O. et al. 2019; Nichtoperative und operative Behandlung der osteoporotischen Wirbelkörperfraktur : Empfehlungen der Sektion Wirbelsäule der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU). Orthopade 48: 84-91
• 13 Benditz A, Jerosch J. Osteoporotische Wirbelkörperfrakturen – Von der Diagnose zur Therapie. Z Rheumatol 2023; 82: 18-24
• 14 López Zúñiga D, Láinez-Ramos-Bossini AJ, Ruiz Santiago F. Radiographic diagnosis of osteoporotic vertebral fractures. An updated review. Med Clin (Barc) 2022; 158: 125-132
• 15 Sih IM, Shimokawa N, Zileli M. et al. Osteoporotic vertebral fractures: radiologic diagnosis, clinical and radiologic factors affecting surgical decision making: WFNS spine committee recommendations. J Neurosurg Sci 2022; 66: 291-299
• 16 Spiegl U, Bork H, Grüninger S. et al. Osteoporotic Fractures of the Thoracic and Lumbar Vertebrae: Diagnosis and Conservative Treatment. Dtsch Arztebl Int 2021; 118: 670-677
• 17 Thomasius F, Baum E, Bernecker P. et al. DVO Leitlinie 2017 zur Prophylaxe. Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und Männern. Osteologie 2018; 27: 154-160
• 18 Heyde C-E, Roth A, Putzier M. Osteoporotische Wirbelkörperfrakturen. Orthopadie (Heidelb) 2023; 52: 808-817
• 19 Chen Z, Shi T, Li W. et al. Role of paraspinal muscle degeneration in the occurrence and recurrence of osteoporotic vertebral fracture: A meta-analysis. Front Endocrinol (Lausanne) 2022; 13: 1073013
• 20 Erhan B, Ataker Y. Rehabilitation of Patients With Osteoporotic Fractures. J Clin Densitom 2020; 23: 534-538
• 21 Pieroh P, Spiegl UJA, Völker A. et al. Spinal Orthoses in the Treatment of Osteoporotic Thoracolumbar Vertebral Fractures in the Elderly: A Systematic Review With Quantitative Quality Assessment. Global Spine J 2023; 13: 59S-72S
• 22 Hoshino M, Tsujio T, Terai H. et al. Impact of initial conservative treatment interventions on the outcomes of patients with osteoporotic vertebral fractures. Spine (Phila Pa 1976) 2013; 38: E641-8
• 23 Kim H-J, Yi J-M, Cho H-G. et al. Comparative study of the treatment outcomes of osteoporotic compression fractures without neurologic injury using a rigid brace, a soft brace, and no brace: a prospective randomized controlled non-inferiority trial. J Bone Joint Surg Am 2014; 96: 1959-1966
• 24 Amans MR, Carter NS, Chandra RV. et al. Vertebral augmentation. Handb Clin Neurol 2021; 176: 379-394
• 25 Hodler J, Peck D, Gilula LA. Midterm outcome after vertebroplasty: predictive value of technical and patient-related factors. Radiology 2003; 227: 662-668
• 26 Pumberger M, Schitz F, Bürger J. et al. Kyphoplasty Restores the Global Sagittal Balance of the Spine Independently from Pain Reduction. Sci Rep 2020; 10: 8894
• 27 Zhu S-Y, Zhong Z-M, Wu Q. et al. Risk factors for bone cement leakage in percutaneous vertebroplasty: a retrospective study of four hundred and eighty five patients. Int Orthop 2016; 40: 1205-1210
• 28 Heyde C-E, Rohlmann A, Weber U. et al. Stabilisierung der osteoporotischen Wirbelsäule unter biomechanischen Gesichtspunkten. Orthopade 2010; 39: 407-416
• 29 Jarvers J-S, Schleifenbaum S, Pfeifle C. et al. Comparison of three different screw trajectories in osteoporotic vertebrae: a biomechanical investigation. BMC Musculoskelet Disord 2021; 22: 418
• 30 Brantley AG, Mayfield JK, Koeneman JB. et al. The effects of pedicle screw fit. An in vitro study. Spine (Phila Pa 1976) 1994; 19: 1752-1758
• 31 Frankel BM, D’Agostino S, Wang C. A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation. J Neurosurg Spine 2007; 7: 47-53
• 32 Tsourdi E, Nees JA, Hofbauer LC. Diagnostik und Therapie der Osteoporose bei geriatrischen Patienten (Osteoporosis in the geriatric population). Dtsch Med Wochenschr 2020; 145: 728-732