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Osteologie 2009; 18(01): 35-40
DOI: 10.1055/s-0037-1619880
Osteologie und Labor
Schattauer GmbH

Knochenstoffwechselmarker bei renaler Osteodystrophie

Bone marker and renal osteodystrophy
M. Haas
1   Universitätsklinik für Innere Medizin III, Abteilung für Nephrologie und Dialyse, Medizinische Universität Wien
,
D. Cejka
1   Universitätsklinik für Innere Medizin III, Abteilung für Nephrologie und Dialyse, Medizinische Universität Wien
› Author Affiliations
Further Information

Publication History

eingereicht: 15 January 2009

angenommen: 21 January 2009

Publication Date:
28 December 2017 (online)

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Zusammenfassung

Die chronische Niereninsuffizienz geht mit einer Störung des Knochenstoffwechsels einher. Diese “renale Osteodystrophie” (ROD) ist im Wesentlichen durch einen beschleunigten oder verlangsamten Knochenumsatz gekennzeichnet. Die Knochenbiopsie ist die genaueste Methode zur Diagnose einer renalen Osteodystrophie, allerdings können auch mittels Messung serologischer Knochenmarker Hinweise auf die zugrundeliegende Form der Erkrankung gefunden werden. Üblicherweise werden zur Abschätzung des Knochenaufbaues Osteokalzin und zur Abschätzung des Knochenabbaues das C-Telopeptid (CTX) bestimmt. Als weiterer effektiver Marker zur Beurteilung der Knochenformation gilt die alkalische Phosphatase. Auch das Parathormon kann zur Beurteilung des Knochenumsatzes herangezogen werden, allerdings ist die Aussagekraft nicht besser als die der anderen Knochenmarker. Nachteilig bei den meisten Knochenmarkern ist ihre renale Elimination. Bei zunehmender Einschränkung der Nierenfunktion kommt es zu einer Kumulation und Verfälschung des tatsächlichen Wertes. Die Bestimmung einzelner Knochenmarker ist daher nicht besonders aussagekräftig und es empfiehlt sich die zeitgleiche Bestimmung mehrerer Marker.

Summary

Chronic renal failure is associated with impaired bone turnover. This so called “renal osteodystrophy” (ROD) is characterized by increased or decreased bone turnover. The diagnostic gold-standard of renal osteodystrophy is the bone biopsy, with subsequent histologic and histomorphometric analyses of the sample. However, also serologic markers might help to elucidate the underlying bone disease. In general, osteocalcin or bone alkaline phosphatase are used as markers of bone formation, and c-telopeptide crosslinks as a marker of bone resorption. Also the serum concentration of the parathyroid hormone can be used to estimate bone turnover. However, the diagnostic reliability of the parathyroid hormone is not superior to that of other serologic bone markers. Most bone markers are excreted by the kidney and cumulate in renal failure. Measurement of only one marker might therefore be misleading. Hence, rather a panel of different markers should be obtained.

Schlüsselwörter

Renale Osteodystrophie - Knochenstoffwechselmarker - Knochenaufbau - Hyperparathyreoidismus - high turnover - low turnover

Keywords

Renal osteodystrophy - bone marker - bone formation - hyperparathyroidism - high turnover - low turnover
 

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