Osteoporose – was tun bei akuter Querschnittlähmung?

Zusammenfassung

Die Querschnittlähmung ist ein hochgradiger Risikofaktor für die Entstehung einer Osteoporose mit gehäuft pathologischen Frakturen der unteren Extremitäten. Bereits in der Akutphase der Lähmung sollte eine Basisdiagnostik durchgeführt werden, um eine unerkannte Osteoporose zu entdecken sowie Ausgangswerte für den weiteren Verlauf zu erhalten. Die Empfehlungen der Arbeitsgruppe Osteoporose der DMGP wurden in Anlehnung an die DVO-Leitlinie “Prophylaxe, Diag-nostik und Therapie der Osteoporose bei Männern ab dem 60. Lebensjahr und bei postmenopausalen Frauen” erarbeitet. Die DXA-Messung und die Bestimmung des Basislabors wird innerhalb von sechs bis acht Wochen nach Lähmungseintritt empfohlen. Als Schwellenwert zur Einleitung der spezifi-schen medikamentösen Osteoporosetherapie bei rollstuhlpflichtiger Querschnittlähmung wird ein T-Score von minus 2,0 oder darunter empfohlen, unabhängig von Alter und Geschlecht. Vitamin D₃ und Kalzium sollten unter bestimmten Voraussetzungen substituiert werden, jedenfalls ab einem T-Wert von minus 1,0 oder darunter. Die Osteoporose -therapie bei Querschnittlähmung ist nur unzureichend evidenzbasiert. Insbesondere die Gabe von spezifischen Osteoporosepräpa-raten erfolgt gegebenenfalls “off-label”.

Summary

The wheelchair-associated paraplegia is a main risk factor for the development of SCI-associated osteoporosis, often followed by pathologic fractures of the lower limbs. Thus, basic diagnostics are recommended in as early as the acute phase after an SCI, to detect an unrecognized osteoporosis, and to obtain initial values to determine a respective prognosis and as appropriate to initiate a basic and also a specific therapy if necessary. The recommendations for diagnostics and therapy of the SCI-associated osteoporosis are based on the DVO-guideline “Prevention, diagnostics and therapy of osteoporosis in men over 60 and in postmenopausal women” (Guideline 2006, revised version 2014). The recommendations of the Osteo porosis Workgroup for beginning a specific therapy in cases of SCI-associated osteoporosis were assessed according to the long-term prednisolone-therapy (daily dose 2,5 to 7,5 mg) as implemented in the DVO-guideline. For the early diagnosis and follow-up of osteopenia and osteoporosis, osteo-densitometry is required. According to WHO, DXA-scan-measurement is the gold-standard and according to DVO, no other methods can be recommended to be routinely performed. Following the recommendations of the Osteoporosis Workgroup, performing an osteo-densitometry with a DXA-scan of the lumbar spine (if no lumbar fracture exists) and at least one hip, 6 to 8 weeks after SCI, and additionally the workup of the basic blood panels is advised as described in the DVO-guideline. Regardless of age and gender, a T-score of minus 2,0 should be the set as the threshold for the specific osteoporosis therapy in cases of wheelchair-associated SCI, even in the acute phase. In accordance with the DVO guidelines, after an SCI, the additional intake of vitamin D₃ and calcium is recommended in cases of inadequate exposure to sunlight or insufficient quantities of calcium in food, respectively. Furthermore, calcium and vitamin D₃ should be always supplemented in patients with a T-score of minus 1,0 or below. The therapy of the SCI-associated osteoporosis is based on a low evidence level. However we shouldn`t deny paraplegic patients the available diagnostic and therapeutic methods, even when the administration of specific osteoporosis medications would be “off label” in use.

Schlüsselwörter

Querschnittlähmung - Osteoporose

Keywords

Paraplegia - osteoporosis

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