Management of osteoporosis-related bone fractures: an integrated concept of care.
BACKGROUND
Multidisciplinary medical management of osteoporosis and osteoporosis-related fractures is still an important treatment issue today. In view of ethiopathology of osteoporosis and the future demographic development an increasing socioeconomic burden has to be estimated. A prerequisite for an effective secondary prophylaxis of osteoporotic fractures is the implementation of a treatment network, with inclusion of all partners involved in patient's care. Therefore, special attention should be paid to formation and establishment of centres with multidisciplinary and integrated treatment concepts. This paper outlines the concept of a clinical centre for diagnosis and therapy of osteoporosis established 4 years ago. Furthermore, a concept of integrated care of osteoporosis-related fractures is introduced and the obtained data of a 2-year follow-up analysis will be presented.


METHODS
The establishment of an osteoporosis centre at a university teaching hospital as well as certification according to the Dachverband Osteologie (DVO) guidelines were necessary. Recruitment of contract partners on both sides, health insurances and outpatient general practitioners as well as specialist doctors, was also essential. The implementation of an osteoporosis coordinator was a step to put the treatment concept into practice.


CONCLUSIONS
Based on the recommendations of DVO guidelines, all diagnostic and therapeutic requirements of osteoporosis can be met by the team of consultant specialists at a clinical osteoporosis centre. In the described treatment concept of integrated care, 44 patients suffering of osteoporosis with a consecutive fracture could be included. Mean age was 77. Inclusion criteria were spinal fractures (61%), proximal femoral fractures (27%) and peripheral fractures (12%). Fifty percent of patients included into the contract had not received previous osteoporosis medication. Sixty-eight patients who met the inclusion criteria could not be included due to the lack of compliance (42%), patients' disapproval (34%) or incomplete treatment and documentation algorithm (24%). Special attention should focus on the completion of standardised diagnosis and documentation. The high amount of time and personnel required has proven the importance of the introduction of an osteoporosis coordinator to be essential.
Strassberger
Carsten
C
Department of Trauma, Reconstructive and Hand-Surgery, Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany. Strassberger-Ca@khdf.de
Unger
Leonore
L
Weber
Andreas T
AT
Defer
Alexander
A
Bonnaire
Felix A
FA
D015502:Absorptiometry, Photon; D000368:Aged; D000465:Algorithms; D015519:Bone Density; D019033:Delivery of Health Care, Integrated; D005260:Female; D050723:Fractures, Bone / Q000209:etiology* / Q000628:therapy*; D005858:Germany; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000150:complications*; D017410:Practice Guidelines as Topic