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Arthritis und Rheuma 2013; 33(02): 77-81
DOI: 10.1055/s-0037-1618168
Diagnostik und Therapie der Spondyloarthritiden
Schattauer GmbH

Osteoporose bei Morbus Bechterew

Osteoporosis in ankylosing spondylitis
D. Mettal-Minski
1   Orthopädisch-rheumatologisches Zentrum, Klinik für Orthopädie, Traumatologie und Rheumatologie, Krankenhaus St. Barbara Attendorn, Attendorn
,
M. Kemmerling
1   Orthopädisch-rheumatologisches Zentrum, Klinik für Orthopädie, Traumatologie und Rheumatologie, Krankenhaus St. Barbara Attendorn, Attendorn
› Author Affiliations
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Publication History

Publication Date:
26 December 2017 (online)

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Zusammenfassung

Bei der Spondylitis ankylosans (SpA) stehen nicht nur Entzündung, Schmerz und Ankylosierungen im Vordergrund, sondern auch eine sekundäre Osteoporose, die oft bei den meist jüngeren Patienten verkannt wird. Im folgenden Beitrag wird das Problem sekundäre Osteoporose bei SpA anhand pathophysiologischer Befunde erklärt, diagnostische und therapeutische Strategien skizziert und auf die klinische Problematik verkannter Frakturen nach Bagatelltraumen hingewiesen. Ergänzt werden die Ausführungen durch Hinweise zur Osteoporoseprophylaxe, die möglichst früh nach Diagnosestellung beginnen sollte.

Summary

In ankylosing spondylitis not only inflammation, pain and ancylosis stand at the front, but also a secondary osteoporosis, which often is disregarded at the mostly young patients. In this chapter, the problem of secondary osteoporosis in ankylosing spondylitis will be described by pathophysiologic results. Diagnostic and therapeutic options will be sketched. At last it has to be referred to the problem of disregarded fractures by low energy traumas. These statements are completed by references to prophylactic options, which have to begin as early as possible.

Schlüsselwörter

Sekundäre Osteoporose - Spondylitis ankylosans - Fraktur - Denosumab

Keywords

Secondary osteoporosis - ankylosing spondylitis - fracture - denosumab
 

  • Literatur

  • 1 Allali F, Breban M, Porcher R. et al. Increase in bone mineral density of patients with spondyloarthropathy treated with anti-tumour-necrosis factor alpha. Ann Rheum Dis 2003; 62: 347-349.
    CrossrefPubMedSearch in Google Scholar
  • 2 Boyle WJ, Simonet WS, Lacey DL. Osteoclast differentiation and activation. Nature 2003; 423: 337-342.
    CrossrefPubMedSearch in Google Scholar
  • 3 Braun T, Zwerina J. Positiv regulators of osteoclastogenesis and bone resorption in rheumatoid arthritis. Arthritis Res Ther 2011; 13: 235-245.
    CrossrefPubMedSearch in Google Scholar
  • 4 Briot K, Gossec L, Kolta S. et al. Prospective assessment of body wight, body composition, and bone density changes in patients with spondyloarthropathy receiving anti-tumour-necrosis factor-alpha treatment. J Rheumatol 2008; 35: 855-861.
    Search in Google Scholar
  • 5 Cooper C, Carbone L, Michet CJ. et al. Fracture risk in patients with ankylosing spondylitis: a population based study. J Rheumatol 1994; 21: 1877-1882.
    Search in Google Scholar
  • 6 Devogelaer JP, Maldague B, Malghem J, Nagant de Deuxchaisnes C. Appendicular and vertebral bone mass in ankylosing spondylitis. A comparison of plain radiographs with single- and dual-photon absorptiometry and with quantitative computed tomography. Arthritis Rheum 1992; 35: 1062-1067.
    CrossrefPubMedSearch in Google Scholar
  • 7 Donnelly S, Doyle DV, Denton A. et al. Bone mineral density and vertebral compression fracture rates in ancylosing spondylitis. Annals Rheum Dis 1994; 53: 117-121.
    CrossrefPubMedSearch in Google Scholar
  • 8 El Maghraoui A, Borderie D, Cherruau B. et al. Osteoporosis, body composition, and bone turnover in ancylosing spondylitis. J Rheumatol 1999; 26: 2205-2209.
    Search in Google Scholar
  • 9 Geusens P, Vosse D, van der Heijde D. et al. High prevalence of thoracic vertebral deformities and discal wedging in ankylosing spondylitis patients with hyperkyphosis. J Rheumatol 2001; 28: 1856-1861.
    Search in Google Scholar
  • 10 Hadjidakis D, Androulakis I. Bone Remodeling. Ann N Y Acad Sci 2006; 1092: 385-396.
    CrossrefPubMedSearch in Google Scholar
  • 11 Heiland GR, Zwerina K, Baum W. et al. Neutralisation of dkk-1 protects from systemic bone loss during inflammation and reduces sclerostin expression. Ann Rheum Dis 2010; 69: 2152-2159.
    CrossrefPubMedSearch in Google Scholar
  • 12 Hofbauer LC, Schoppet M. Clinical implications of the osteoprotergin/RANK-LIGAND/RANK system for bone and vascular diseases. JAMA 2004; 292: 490-495.
    CrossrefPubMedSearch in Google Scholar
  • 13 Hsu H, Lacey DL, Dunstan CR. et al. Tumor necrosis factor family member RANK mediates osteoclast differentiation and activation induced by osteoprotergin ligand. Proc Natl Acad Sci USA 1999; 96: 3540-3545.
    CrossrefPubMedSearch in Google Scholar
  • 14 Karberg K, Zochling J, Sieper J. et al. Bone loss is detected more frequently in patients with ancylosing spondylitis with syndesmophytes. J Rheumatol 2005; 32: 1290-1298.
    Search in Google Scholar
  • 15 Maillefert JF, Aho LS, El Maghraoui A. et al. Changes in bone density in patients with ankylosing spondylitis: a two–year follow-up study. Osteoporos Int 2001; 12: 605-609.
    CrossrefPubMedSearch in Google Scholar
  • 16 Ney JT, Fehm T, Juhasz-Boess I. et al. RANK, RANKL and OPG expression in breast cancer – influence on osseous metastasis. Geburtsh Frauenheilk 2012; 72: 385-391.
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Redlich K, Smolen J. Inflammatory bone loss: pathogenesis and therapeutic intervention. Nat Rev Drug Discov 2012; 11: 234-250.
    CrossrefPubMedSearch in Google Scholar
  • 18 Tarner IH. Entzündlich rheumatische Erkrankungen und Osteoporose. arthritis + rheuma 2012; 32: 375-383.
    Search in Google Scholar
  • 19 Vosse D, Ladewé R, van der Heijde D. et al. Ankylosing spondylitis and the risk of fracture: results from a large primary care-based nested case-control study. Ann Rheum Dis 2009; 68: 1839-1842.
    CrossrefPubMedSearch in Google Scholar