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Osteologie 2012; 21(04): 269-273
DOI: 10.1055/s-0037-1621694
Osteonekrosen
Schattauer GmbH

Update Ätiologie/Risikofaktoren bei Osteonekrosen und Osteonekrose bei Kortikoidtherapie

Update etiology and risk factors in osteonecrosis and osteonecrosis and steroids
C. P. Rader
1   Praxisklinik Orthopädie Franziskushospital, Aachen
,
B. Baumann
2   Kniechirurgie, Hüftchirurgie, Schulterchirurgie, Schön Klinik München Harlaching
› Institutsangaben
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Publikationsverlauf

eingereicht: 30. Juli 2012

angenommen: 13. August 2012

Publikationsdatum:
04. Januar 2018 (online)

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Zusammenfassung

Schon seit Beginn der 1980iger-Jahre wird eine multifaktorielle Genese der Osteonekrose postuliert. Neueste Untersuchungen fokussieren auf die Endstreckengefäße. Die Summe der Risikofaktoren führt durch erkrankte Endothelien zum Verschluss der Endgefäße mit der Folge der umschriebenen Nekrose eines typischen Knochenbezirks. Diese Theorie der endothelialen Dysfunktion wird durch molekularmedizinische Verfahren unterstützt. Besonders das VEGF (vascular endothelial growth factor) der Knochenmarkszellen steht im Mittelpunkt des Interesses, da dieser Wachstumfaktor die Angiogenese und damit die Regenerationsfähigkeit des Knochens anzeigt. Bei Osteonekrose wird er vermindert und/oder in abnormer Variante exprimiert. Für die kortisoninduzierte Osteonekrose, deren Verständnis durch zahlreiche Tiermodelluntersuchungen deutlich verbessert wurde, gilt, dass sie durch kumulative Gabe oder durch sehr hohe Einzeldosen ausgelöst wird. Die Regenerationsfähigkeit ist beim Risikofaktor Kortison deutlich niedriger als bei anderen Risikofaktoren wie Alkohol.

Summary

The multifactorial concept of osteonecrosis is postulated since the 1980s. New studies focused on function of the terminal vessels. Accumulated risk factors lead to clotted vessels by endothelial disease. The consequences are located necrosis of typical bone areas. This concept of endothelial dysfunction is supported by molecular technique. Especially VEGF (vascular endothelial growth factor) stands in the centre of attention, because the growth factor mediated angiogenesis and bone regeneration. VEGF is down regulated in osteonecrosis and/or expressed in an abnormal variant. A lot of studies with animals were done in the field of steroidinduced osteonecrosis. Accumulated dosages and peak doses of steroids provoke osteonecrosis. The regeneration ability is still inferior in steroid-induced osteonecrosis in comparison to other risk factors like alcohol.

Schlüsselwörter

Nicht traumatische Osteonekrose - Osteonekrose bei Kortikoidtherapie - VEGF

Keywords

Non-traumatic osteonecrosis - osteonecrosis and steroids - vascular endothelial growth factor
 

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