Neuerburg Carl, Mittlmeier Lena, Schmidmaier Ralf, Kammerlander Christian, Böcker Wolfgang, Mutschler Wolf, Stumpf Ulla
Department of General, Trauma and Reconstruction Surgery, Munich University Hospital LMU, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany.
Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany.
J Orthop Surg Res. 2017 Jun 8;12(1):86. doi: 10.1186/s13018-017-0585-0.
Osteoporosis-associated fractures are of increasing importance in trauma surgery. Systematic diagnostics and treatment of osteoporosis during a hospital stay, however, remain inadequate. Therefore, a specific algorithm for diagnosing and treating osteoporosis in trauma surgery patients was developed based on the DVO (German Osteology Society) guideline for osteoporosis from 2014.
In a first step, the individuals' age and risk profile for osteoporosis is identified considering specific fractures indicating osteoporosis and risk factors assessed by a specific questionnaire. In addition, physical activity, risk of falls, dietary habits and the individuals' medication are considered. Basic osteoporosis laboratory tests, a bone densitometry by dual-energy X-ray absorptiometry (DXA) and, if needed, X-rays of the spine are carried out to identify prevalent vertebral body fractures.
Based on the treatment algorithm adapted to the new guidelines for osteoporosis in the majority of proximal femoral fractures, treatment of osteoporosis could already be indicated without prior DXA. In case of preexisting glucocorticoid therapy, a history of previous fractures or other risk factors according to the risk questionnaire, the threshold of treatment has to be adjusted given the table of T-scores.
The treatment algorithm for diagnosing and treating osteoporosis in in-patient trauma surgery patients can help identify high-risk patients systematically and efficiently. As a result, osteoporosis-associated fractures or failure of osteosynthesis could be reduced, yet a prospective validation of the algorithm has to be completed.
骨质疏松相关骨折在创伤外科中的重要性日益增加。然而，住院期间对骨质疏松的系统诊断和治疗仍然不足。因此，基于2014年德国骨科学会（DVO）的骨质疏松指南，制定了一种针对创伤外科患者骨质疏松的诊断和治疗的特定算法。
第一步，考虑表明骨质疏松的特定骨折以及通过特定问卷评估的风险因素，确定个体的年龄和骨质疏松风险状况。此外，还要考虑身体活动、跌倒风险、饮食习惯和个体用药情况。进行基本的骨质疏松实验室检查、双能X线吸收法（DXA）骨密度测定，必要时进行脊柱X线检查，以确定是否存在椎体骨折。
基于适用于大多数股骨近端骨折骨质疏松新指南的治疗算法，在未进行DXA检查之前即可指示进行骨质疏松治疗。如果存在糖皮质激素治疗史、既往骨折史或根据风险问卷的其他风险因素，则必须根据T值表调整治疗阈值。
住院创伤外科患者骨质疏松的诊断和治疗算法有助于系统且高效地识别高危患者。因此，可减少骨质疏松相关骨折或骨合成失败的情况，但该算法仍需进行前瞻性验证。
