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DOI: 10.1055/s-0037-1622048
Querschnittlähmung – ein osteologischer Problemfall
Spinal cord injury – an osteological problemPublication History
eingereicht:
18 August 2014
angenommen:
28 September 2014
Publication Date:
02 January 2018 (online)
Zusammenfassung
Nach Querschnittlähmung setzt rasch ein Verlust der Knochendichte unterhalb der Läsion ein, insbesondere am distalen Femur und an der proximalen Tibia beidseits. Der Knochenabbau, der mehrere Monate bis Jahre anhält und mit der Zeit langsamer verläuft, ist abhängig von der Höhe der Läsion; die Spongiosa ist mehr davon betroffen als die Kortikalis. Parallel zum Knochenverlust kann laborchemisch unter anderem ein Anstieg von Kalzium und Crosslinks im Urin nachgewiesen werden. Die Erkrankung geht mit einem erhöhten Frakturrisiko einher, typischerweise im Bereich des distalen Femurs und der proximalen Tibia. Frakturen können dort bei normalen Aktivitäten des Lebens ohne adäquates Trauma auftreten. Die Frakturhäufigkeit steigt mit dem Zeitintervall nach der Querschnittlähmung. Als Ursachen der Osteoporose bei Querschnitt werden neben der reinen mechanischen Entlastung vielmehr neurogene, vaskuläre und hormonelle Mechanismen diskutiert.
Summary
After spinal cord injury, there is a rapid loss of bone density below the lesion, highest at the distal femur and proximal tibia on both sides. The bone loss depends from the level of the lesion, and the cancellous bone is more affected than the cortex. The rapid initial bone loss lasts for several months to years, thereafter it continues slowly. Biochemically parallel to the bone loss among an increase of calcium and crosslinks in urine can be observed. The disease is associated with an increased risk of fracture, typically in the region of the distal femur and proximal tibia; fractures can occur during normal activities of life without adequate trauma. The fracture incidence increases with the time interval after the paraplegia. As causes of osteoporosis in addition to a pure mechanical relief rather neurogenic, vascular and hormonal mechanisms are discussed.
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