SOP Diagnostik bei Osteoporoseverdacht

In orthopädisch-unfallchirurgischen Praxen gewinnt das Thema Osteoporose zunehmend an Bedeutung. Seit 2003 gibt es deutschsprachige evidenzbasierte Leitlinien für die Diagnostik und die Therapie der Osteoporose, die immer wieder der neuesten wissenschaftlichen Entwicklung angepasst wurden. Auf diese Leitlinien kann man die klinischen Entscheidungen für die Diagnostik und Therapie basieren. Das Erkennen der Patient*innen mit einem Risiko für eine osteoporotische Fraktur und die frühzeitige Diagnostik sind die wichtigsten Schritte in der Versorgung.

Schlüsselwörter

Knochendichte - Osteoporose - Skeletterkrankung - Frakturrisiko

Publication History

Article published online:
05 June 2024

• Literatur

• 1 Genant HK, Cooper C, Poor G. et al. Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis. Osteoporos Int 1999; 10: 259-264
• 2 Tarantino U, Cariati I, Greggi C. et al. Gaps and alternative surgical and non-surgical approaches in the bone fragility management: an updated review. Osteoporos Int 2022; 33: 2467-2478
• 3 Kurth AA, Salzmann M, Stumpf U. et al. Eine regionale Analyse der Tertiärprävention. Osteologie 2018; 27: 135-143
• 4 Kanis JA, Johnell O, Oden A. et al. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 2001; 12: 989-995
• 5 Kanis JA, Johansson H, Oden A. et al. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Mineral Research 2004; 19: 893-899
• 6 Vilaca T, Schini M, Harnan S. et al. The risk of hip and non-vertebral fractures in type 1 and type 2 diabetes: A systematic review and meta-analysis update. Bone 2020; 137: 115457
• 7 Bai J, Gao Q, Wang C. et al. Diabetes mellitus and risk of low-energy fracture: a meta-analysis. Aging Clin Exp Res 2020; 32: 2173-2186
• 8 Dachverband Osteologie e. V.. Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und bei Männern ab dem 50. Lebensjahr. 2023 Accessed January 31, 2024 at: https://register.awmf.org/assets/guidelines/183–001l_S3_Prophylaxe-Diagnostik-Therapie-der-Osteoporose_2023–11.pdf
• 9 Blake GM, Fogelman I. The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgrad Med J 2007; 83: 509-517
• 10 Fuggle NR, Curtis EM, Ward KA. et al. Fracture prediction, imaging and screening in osteoporosis. Nat Rev Endocrinol 2019; 15: 535-547
• 11 Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996; 312: 1254-1259
• 12 Shepherd JA, Schousboe JT, Broy SB. et al. Executive Summary of the 2015 ISCD Position Development Conference on Advanced Measures From DXA and QCT: Fracture Prediction Beyond BMD. J Clin Densitom 2015; 18: 274-286
• 13 Nishiyama KK, Shane E. Clinical imaging of bone micro-architecture with HR-pQCT. Curr Osteoporos Rep 2013; 11: 147-155
• 14 Klotzbuecher CM, Ross PD, Landsman PB. et al. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 2000; 15: 721-739
• 15 Genant HK, Wu CY, van Kuijk C. et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993; 8: 1137-1148
• 16 Melton 3rd LJ, Atkinson EJ, Cooper C. et al. Vertebral fractures predict subsequent fractures. Osteoporos Int 1999; 10: 214-221
• 17 Lindsay R, Silverman SL, Cooper C. et al. Risk of new vertebral fracture in the year following a fracture. JAMA 2001; 285: 320-323
• 18 Johansson H, Odén A, McCloskey EV. et al. Mild morphometric vertebral fractures predict vertebral fractures but not non-vertebral fractures. Osteoporos Int 2014; 25: 235-241
• 19 Gausden EB, Nwachukwu BU, Schreiber JJ. et al. Opportunistic use of CT imaging for osteoporosis screening and bone density assessment: a qualitative systematic review. J Bone Joint Surg Am 2017; 99: 1580-1590
• 20 Kanis JA, Johansson H, Harvey NC. et al. The use of 2-, 5-, and 10-year probabilities to characterize fracture risk after a recent sentinel fracture. Osteoporos Int 2021; 32: 47-54
• 21 Johansson H, Siggeirsdóttir K, Harvey NC. et al. Imminent risk of fracture after fracture. Osteoporos Int 2017; 28: 775-780
• 22 Weinstein RS. Clinical practice: glucocorticoid-induced bone disease. N Engl J Med 2011; 365: 62-70
• 23 Mortensen SJ, Mohamadi A, Wright CL. et al. Medications as a risk factor for fragility hip fractures: a systematic review and meta-analysis. Calcif Tissue Int 2020; 107: 1-9