Abstract
Purpose On a global scale the main focus of traumatological therapy lies in the treatment
of unintentional injuries or victims of violence. People of all ages and through all
economic groups can be affected. Due to demographic change in Western industrial countries,
however, this focus increasingly shifts towards fragility fractures. In Europe osteoporosis
is the most common bone disease in advanced age. Secondary prevention programs like
the Fracture Liaison Service (FLS) are becoming increasingly prevalent, especially
in Anglo-American health care systems. In German orthopedic and trauma wards and hospitals,
however, the FLS is still relatively uncommon. This article will examine the question
whether secondary prevention programs like FLS need to be established in the German
health care system. This study aims at finding out, whether in the area of a medium
sized German city there is a difference regarding the initiation of osteoporosis diagnosis
and therapy
between the regular aftercare by the general practitioner or the orthopedic surgeon
and the aftercare by a specialist trained in osteology (Osteologe).
Materials and Methods For the open, randomized prospective study 70 patients with low energy fractures
were recruited, who were older than 60 years and have been treated in our department.
Results 58 out of 70 patients have completed the study, which amounts to a follow-up of 82.9%.
Limited mobility and a high degree of organizational effort were the main reasons
for early termination of the study. While in the group with regular aftercare, only
2 out of 29 patients received a specific osteoporosis treatment, in group who were
directly transferred to a specialist trained in osteology 17 out of 29 patients received
specific treatment. After re-evaluation of group with regular aftercare in 21 out
of 29 cases a specific osteoporosis treatment was recommended.
Conclusions It could be established that there is a significant diagnosis and treatment gap regarding
the aftercare of patients with fractures caused by osteoporosis between general practitioners
or orthopedic surgeons on the one hand and the specialists trained in osteology on
the other hand. To improve the aftercare of fracture patients, cross sectoral networks
with a background in geriatrics and orthopedic-trauma surgery like a FLS need to be
established in the German healthcare system.
Key words
fracture liaison service - osteoporosis - fractures caused by osteoporosis
