[The prevalence of osteoporosis and associated health care use in women 45 years and older in Germany. Results of the first German Telephone Health Survey 2003]

The prevalence of osteoporosis and associated factors were assessed among women 45 years and older as part of the first nationwide German Telephone Health Survey (GSTel03). A total of 14.2% of women reported that a doctor had ever diagnosed them with osteoporosis. Among these about, 15% also reported a physician-diagnosed fragility fracture, the fracture question was restricted to the subgroup of women with osteoporosis. Point estimates of overall osteoporosis prevalence increased significantly across 10-year age bands from 4% in the lowest to 30% in the highest age group. There was no significant association of osteoporosis with socioeconomic status or residence in former East vs West Germany; however, osteoporosis was significantly overrepresented among women with a migration background in comparison to women born in Germany (age-adjusted odds ratio: 1.68; 95% CI: 1.07-2.63). In age-adjusted logistic regression models, osteoporosis was significantly related to physician-diagnosed arthritis or rheumatoid arthritis, significant stature loss (>5 cm) compared to height at age 25 years, postmenopausal hormone therapy, lower ratings of subjective health as well as increased utilization of health care services. No significant association was observed with body mass index computed from self-reported height and weight. In conclusion, despite methodological limitations, these population-based, representative data support the observation that osteoporosis is a prevalent and serious health problem among older women and reflect the considerable variability with regard to diagnosis and management of this condition. Studies evaluating quality of care as well as monitoring of disease endpoints and risk factors based on representative samples of the population are needed.

Transiliac bone biopsy in osteoporosis: frequency, indications, consequences and complications. An evaluation of 99 consecutive cases over a period of 14 years

Bone biopsy is a diagnostic procedure restricted to untypical, unclear and complicated cases in evidence-based guidelines on diagnosis and treatment of osteoporosis. Its relevance has been a topic of recent controversial discussion. This study was performed to evaluate its role and relevance in routine use. A total of 99 horizontal transiliac bone biopsies performed over a time period of 14 years because of an osteological indication in one single centre were analysed, which reflects that bone biopsy followed about 0.003% of patients' consultations. Bone biopsies were indicated for osteoporotic males (n = 63) and premenopausal osteoporotic females (n = 18) without endocrine abnormality and normal immunofixation (serum and urine), suspected systemic/malignant disease such as mastocytosis, osteogenesis imperfecta, non-secreting plasmocytoma, metastatic infiltration (n = 16) and decreasing bone mineral density under anti-osteoporotic treatment (n = 2). The most frequent diagnoses besides osteoporosis were normal histology, borderline finding towards mild osteoporosis, and osteoporomalacia with relevant osteoidosis. In some cases, pathological findings in bone marrow were detected. In most cases (82/99), bone biopsy led to consequences in medical treatment. Following histopathological diagnosis, 16 patients did not receive any anti-osteoporotic treatment. In six patients, further diagnostic procedures were initiated because of bone histology. Bone biopsy was well tolerated and complications were rare and mild. In conclusion, despite all progress in non-invasive diagnostic procedures for metabolic bone diseases such as osteoporosis, there remains a small but significant subset of patients who may benefit from inclusion of bone biopsy into the diagnostic procedure.

[Trauma surgery in the elderly]

The indications for the surgical treatment of fractures in elderly patients should consider the individual's general health status, the specific pattern of injury, and the ability of the patient to actively participate in the rehabilitation process. Intramedullary systems are the gold standard for shaft and metaphyseal fractures due to the decreased operative trauma and the possibility of early weight bearing and functional treatment. Minimally invasive locking plate systems can frequently be applied, offer decreased risk of secondary fracture displacement, and have great advantages in the treatment of periprosthetic fractures with firm implants. The possible reasons for falls should be diagnosed in order to allow their prevention. An exact assessment of the severity of osteoporosis in important in allowing adequate treatment for associated pain and for decreasing the risk of future osteoporosis related fractures.