Bildgebung der diabetischen Knochenerkrankung

T. M. Link; U. Heilmeier

doi:10.1055/s-0037-1619013

Osteologie, Table of Contents

Osteologie 2016; 25(03): 186-192
DOI: 10.1055/s-0037-1619013

Muskuloskelettale Radiologie

Schattauer GmbH

Bildgebung der diabetischen Knochenerkrankung

Aktuelle ForschungsergebnisseImaging of diabetic bone diseaseCurrent Research Update

T. M. Link

¹Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA

,

U. Heilmeier

¹Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA

› Author Affiliations

Abstract

Zusammenfassung

Patienten mit Typ-2-Diabetes mellitus (T2DM) weisen eine erhöhte Frakturinzidenz auf und dies trotz normaler oder erhöhter, mittels DXA gemessener Knochendichtewerte. Die Gründe für die erhöhte Frakturanfälligkeit des diabetischen Knochens sind noch nicht geklärt. In den vergangenen zehn Jahren wurden neue bildgebende Verfahren entwickelt, die die Knochenqualität und -struktur von Patienten mit T2DM charakterisieren und vielversprechende Ergebnisse zeigen. Eines dieser Verfahren ist die sogenannte hochauflösende quantitative Computertomografie (HR-pQCT), die es erlaubt, die kortikale und trabekuläre Struktur peripherer Knochen zu analysieren. Klinische Studien zeigten, dass die Porosität des kortikalen Knochens bei T2DM-Patienten mit Frakturen erhöht ist. Die Magnetresonanzspektroskopie des Knochenmarks ist eine weitere bildgebende Technik, die in klinischen Studien mit einer erhöhten Prävalenz von Frakturen assoziiert war. Des Weiteren wurden der quantitative Knochenultraschall und der “Trabecular Bone Score” (DXA) zur Charakterisierung der Knochenqualität bei T2DM-Patienten eingesetzt. Dieser Übersichtsartikel fasst aktuelle Studien zur bildgebenden, quantitativen Diagnostik der diabetischen Knochenerkrankung zusammen und zeigt, dass neue Verfahren vielversprechende Ansätze zur besseren Beurteilung des diabetischen Frakturrisikos liefern.

Summary

Patients with type 2 diabetes mellitus (T2DM) have a higher incidence of fragility fractures despite normal or even elevated bone mineral density (BMD) measured with DXA. Recent clinical studies have shown that bone structure and composition may explain the increased risk of fragility fractures in T2DM and provide information on bone strength beyond this provided by BMD. High resolution quantitative computed tomography (HR-pQCT) is a new technology to investigate bone quality analyzing cortical and trabecular bone structure. Using HR-pQCT differences in cortical porosity at the distal radius and tibia between T2DM patients with and without fragility fractures were found. It has been suggested that cortical porosity may serve as a new imaging biomarker for increased fragility in T2DM. In addition abnormalities of bone marrow fat using MR spectroscopy of the spine were demonstrated in T2DM patients: vertebral bone marrow fat content correlated significantly with HbA1c and visceral adipose tissue in T2DM patients and decreased unsaturated bone marrow lipids were found to be associated with T2DM and fragility fractures. Other imaging technologies that have been used to assess bone structure and texture in diabetic bone disease are high resolution MRI, quantitative ultrasound and trabecular bone score derived from DXA images. This chapter will summarize results from recent studies analyzing bone quality in patients with diabetic bone disease and will demonstrate how novel imaging technologies may better characterize fracture risk in these patients.

Schlüsselwörter

Knochenstruktur - Knochenqualität - Fragilität des Knochens - Typ-2-Diabetes mellitus - diabetische Osteopathie - HR-pQCT - Knochen - mikroarchitektur - TBS

Keywords

Bone structure - bone quality - bone fragility - type 2 diabetes mellitus - diabetic bone disease - HR-pQCT - bone microarchitecture - TBS

Full Text

References

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