[Osteoporosis--a neglected issue in orthopaedics? Results of a survey amongst German orthopaedic surgeons]

[Compliance of osteoporosis patients with additional specific osteoporosis-training course]

BACKGROUND

In the present study patients with an osteoporotic fracture were examined in order to determine how many patients decided to continue their therapy as outpatients having taken part in osteoporosis training at the Dr. Becker Rhein-Sieg Clinic.

PATIENTS AND METHODS

Patients who had previously suffered an osteoporotic fracture and thereafter received inpatient rehabilitation were selected for the study. Patients (n = 95) who had taken part in inpatient rehabilitation after an osteoporotic fracture were approached either via telephone or mail and were then followed up after 6 and 12 months with regard to their adherence to the treatment.

RESULTS

From a total of 95 patients, after 6 months 82 % (n = 78) were contacted successfully and included in the study. 68 out of 78 patients (72 %) had continued their medication. After 1 year 76 % of patients (n = 72) were successfully contacted once. Here, 62 % of patients (n = 59) had continued their medication under medical supervision. In the 1‑year follow-up period there were eight cases of falls, and one of these resulted in a peripheral fracture, which was treated conservatively.

CONCLUSION

Osteoporosis-specific information and osteoporosis training of patients after osteoporotic fracture are important tools to improve the motivation and compliance of patients. One possibility to realize this is osteoporosis-specific training with video presentations and individual care and education of the patients within outpatient or inpatient rehabilitation.

Osteoporosis in German men: a cost-of-illness study

Costs of male osteoporosis may have increased due to population aging and change of treatment patterns. This cost-of-illness study provides a current estimate of the economic burden of male osteoporosis in Germany. Routine claims data from six German sickness funds were analyzed and extrapolated to the German statutory health insurance (SHI). For men above the age of 50 with at least one ICD-10 osteoporosis-related diagnosis or osteoporosis-related fracture in 2010, direct costs related to osteoporosis were considered based on a payer's perspective. Total direct costs attributable to osteoporosis amounted to €728 million in 2010. The majority of these costs (71%) resulted from inpatient treatment due to fractures. Patients aged 75 and older caused approximately 63% of costs. Male osteoporosis represents a non-negligible economic burden for the German health care system. Targeted prevention and promotion measures should be offered both to men and women.

Osteoporosis prevalence and fracture characteristics in elderly female patients with fractures

PURPOSE

The aim of this study was to characterize the features of fractures that occur in female patients with osteoporosis in the setting of a typical trauma hospital.

METHODS

Observational study was conducted on 233 women aged 50 years and above reporting to a trauma center with a fracture. Fracture location, fracture classification and cause of fracture were obtained and compared with bone mineral status assessed by DXA at the spine.

RESULTS

Our findings indicate that with increasing patient age, the majority of fractures occur after a minor traumatic event. In more than one-third of all fractures after minor trauma, the patients were diagnosed with osteoporosis. The overall prevalence of osteoporosis in patients older than 50 years with fractures was more than 30% and was increasing with age. Most strikingly, one-third of the patients have had a previous fracture at a location that should have triggered the assessment of bone health status, but only 25% of them had received any form of osteoporosis treatment.

CONCLUSION

For patients older than 50 years reporting to a trauma unit with a fracture, osteoporosis has a considerable prevalence. The large number of patients who have had a previous fracture emphasizes the necessity for an effective implementation of treatment algorithms for elderly patients with osteoporosis in the setting of a trauma hospital.

[Reality of treatment of osteoporotic fractures in German trauma departments. A contribution for outcome research]

The implementation of clinical pathways has a proven positive effect on the diagnostic workup and initiation of therapy in osteoporotic fracture patients. Unlike in most countries, fracture care in Germany is provided by so-called trauma surgeons. Therefore, it is essential to focus on the trauma surgeon for correct diagnostic workup and therapy initiation after a fragility fracture. A questionnaire was mailed to 409 departments of traumatology inquiring about the existence of a standardized clinical pathway for diagnosis and treatment of patients with fragility fractures. One of the central issues of the survey was whether those pathways comply with national guidelines. Only institutions that stated that they followed a clinical pathway were analyzed. 80% of institutions took part in our survey, 35% of which reported following a defined clinical pathway. Diagnostic workup is in concordance with the national guidelines in 30%, and therapy is guideline-based in 51%, with 12% basing both diagnostic workup and therapy on the guidelines. Thus, the vast majority of German traumatology departments do not follow national guidelines regarding osteoporosis diagnostics and therapy in patients with fragility fractures, leading to a great opportunity to improve fragility fracture care by means of both education and interdisciplinary cooperation.

[Metabolic bone diseases]

Osteomalacia is caused by impaired vitamin D receptor (VDR) signaling, calcium deficiency, and altered bone mineralization. This can be due to insufficient sunlight exposure, malabsorption, reduced D hormone activation in chronic kidney disease, and rare alterations of VDR signaling and phosphate metabolism. Leading symptoms are bone pain, muscular cramps, and increased incidence of falls in the elderly. The adequate respective countermeasures are to optimize the daily intake of calcium and vitamin D3 and to replace active D hormone and phosphate if deficient. Osteoporosis is characterized by bone fragility fractures upon minor physical impact. Indications for diagnosis and treatment can be established by estimating the absolute fracture risk, taking into account bone mineral density, age, gender, and individual risk factors. Exercise, intervention programs to avoid falls, and specific drugs are capable of substantially reducing fracture risk even in the elderly. Secondary osteoporosis primarily requires both bone-altering medications and effective treatment of underlying diseases.