Neuerburg C, Schmidmaier R, Schilling S, Kammerlander C, Böcker W, Mutschler W, Stumpf U
Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie, Osteologisches Schwerpunktzentrum (DVO), Klinikum der Ludwig-Maximilians-Universität München, Campus Innenstadt, Nußbaumstr. 20, 80336, München, Deutschland.
Medizinische Klinik und Poliklinik IV, Osteologisches Schwerpunktzentrum (DVO), Klinikum der LMU München, München, Deutschland.
Unfallchirurg. 2015 Nov;118(11):913-24. doi: 10.1007/s00113-015-0071-2.
Osteoporosis-associated fractures are of increasing importance in trauma surgery. The implementation of systematic diagnostics and treatment of osteoporosis during hospitalization, however, remains insufficient; therefore, a specific algorithm for the diagnosis and treatment of osteoporosis in trauma surgery patients was developed based on the German Osteology Society (Dachverband Osteologie, DVO) guidelines for osteoporosis from 2014. In a first step, the individual patient age and risk profile for osteoporosis are identified considering specific fractures indicative of osteoporosis. For these patients a questionnaire is completed which detects specific risk factors. In addition, the physical activity, risk of falls, dietary habits and the individual medication are collated as these can have a decisive influence on the subsequent therapy decisions. Prior to a specific treatment, laboratory osteoporosis tests, bone densitometry by dual energy X-ray absorptiometry (DXA) and if needed X-rays of the spine are carried out. For proximal femoral fractures the treatment of osteoporosis could already be indicated. With pre-existing glucocorticoid therapy, a history of previous fractures or other risk factors according to the risk questionnaire, the threshold of treatment has to be adjusted according to the table of T-scores detected by DXA. The treatment algorithm for diagnostics and treatment of osteoporosis in hospitalized trauma surgery patients can systematically and efficiently improve the identification of patients at risk. Thus, further fractures associated with osteoporosis or failure of internal fixation could be reduced in future. A prospective validation of the algorithm has already be initiated.
骨质疏松相关性骨折在创伤外科中的重要性日益增加。然而，住院期间骨质疏松症的系统诊断和治疗实施情况仍然不足；因此，基于德国骨科学会（Dachverband Osteologie, DVO）2014年骨质疏松症指南，制定了创伤外科患者骨质疏松症诊断和治疗的特定算法。第一步，考虑提示骨质疏松症的特定骨折，确定个体患者的年龄和骨质疏松风险状况。对于这些患者，需完成一份问卷以检测特定风险因素。此外，整理身体活动情况、跌倒风险、饮食习惯和个人用药情况，因为这些因素可能对后续治疗决策产生决定性影响。在进行特定治疗之前，需进行实验室骨质疏松检测、双能X线吸收法（DXA）骨密度测定，必要时进行脊柱X线检查。对于股骨近端骨折，可能已需进行骨质疏松症治疗。对于已接受糖皮质激素治疗、有既往骨折史或根据风险问卷存在其他风险因素的情况，治疗阈值必须根据DXA检测的T值表进行调整。住院创伤外科患者骨质疏松症诊断和治疗的算法可系统、有效地改善对高危患者的识别。因此，未来可减少与骨质疏松症相关的进一步骨折或内固定失败的情况。该算法的前瞻性验证已经启动。
