title: [Evaluation and socio-economic relevance of an integrated osteoporosis health care network].
abstract: During the last 6 to 7 years, integrated health care has become more and more important in Germany. In August 2005 we initiated a collaborative project involving two orthopaedic clinics in Hanover and one rehabilitation clinic in Bad Pyrmont specialising in the treatment of osteoporosis. Here, we report the results of 633 women (83 ± 7 years) and 162 men (75 ± 10 years) who participated in this programme between August 2005 and August 2012. All participants gave informed consent. All patients were supplemented with 1200 mg of calcium and 800 IU of vitamin D. Intravenous bisphosphonates were given to 91% and parathyroid hormone to 7% of the patients. Two per cent received miscellanous therapeutic agents. Follow-up visits were attended by 89% of the patients after one year and 78% after two years. During this time, a significant improvement was observed in vitamin D, parathyroid hormone and the bone marker desoxypyridinoline. DXA measurements were falsified by degenerative disease or fractures. In the men, however, a significant increase was observed in the total hip. Over the two-year period, 16 vertebral and 3 non-vertebral fractures occurred in the women. In the men, one non-vertebral and 5 vertebral fractures were noted. Among the women, 18 died and 6 were admitted to a nursing home. The corresponding figures among the men were 7 and 4, respectively. According to the figures provided by the central German institute for statistics, the death rates among the women were significantly lower than expected, whereas a tendency toward lower death rates was seen in the men. In addition, the number of new hip fractures in the women was lower than the epidemiological data suggest. This was also noted in the men. Even among the very old, a musculoskeletal rehabilitation programme combined with adequate pharmaceutical therapy may prove very successful when it comes to death rates and nursing home admissions. The latter in particular may be very expensive in the long run and our longitudinal follow-up study may demonstrate cost-effectiveness if the rehabilitation programme is commenced as early as possible.
authors.affiliation: Institut für Klinische Osteologie Gustav Pommer und der klinik DER FÜRSTENHOF, Bad Pyrmont.
authors.forename: M
authors.initials: M
authors.lastname: Pfeifer
authors.forename: Ch
authors.initials: Ch
authors.lastname: Hinz
authors.forename: A D
authors.initials: AD
authors.lastname: Lazarescu
authors.forename: H W
authors.initials: HW
authors.lastname: Minne
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000191:economics / Q000627:therapeutic use*; D015984:Causality; D003131:Combined Modality Therapy / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data; D019058:Community Networks / Q000191:economics / Q000706:statistics & numerical data; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000706:statistics & numerical data; D005081:Exercise Therapy / Q000191:economics* / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D010024:Osteoporosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D058866:Osteoporotic Fractures / Q000191:economics* / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents