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  • 1
    Language: German
    In: Orthopädie und Unfallchirurgie - Mitteilungen und Nachrichten, 2015, Vol.04(02), pp.177-177
    Description: Der Knochengesundheit im Kindes- und Jugendalter kommt eine große Bedeutung zu, da in jungen Jahren die sogenannte ,,peak bone mass“, also die individuelle maximale Knochenmasse aufgebaut wird. Grundvoraussetzung für eine ungestörte Knochenentwicklung sind die beiden Bereiche Ernährung und Bewegung.
    Keywords: DGOOC
    ISSN: 2193-5254
    E-ISSN: 2193-5262
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  • 2
    Language: English
    In: Wiener klinische Wochenschrift, 2012, Vol.124(11), pp.391-394
    Description: Several studies evaluated hip fracture incidences and its predictors and trends using hospital discharge registries. However, this source does not provide patient-related data, therefore the hospital changes or re-hospitalisations cannot be identified as “double counting”. If double counting differs with age, sex, region, and time, the estimates may be biased. Aim of our study was to evaluate the magnitude of multiple counting and, in particular, its variation with age, sex, region, and calendar year. We used data of a German-wide health insurance (1.6 million members). Between 1998 and 2009, we assessed all hip fractures (ICD 9: 820, ICD 10: S.72.0–2) in individuals aged 50 years or older and calculated the probability to be a patient’s “first” fracture in each calendar year. Using multiple logistic regressions, we estimated the influence of age, sex, region, and calendar year. The probabilities of a “first fracture” per patient and year varied between 86.7 % (95 % confidence interval 83.9–89.2 %, year 2003) and 93.9 % (90.9–96.2 %, year 1998). Age (odds ratio per 5 years 0.89; 95 % CI 0.86–0.92), region (East vs. West Germany: 0.65; 0.52–0.81), and calendar year (per year 0.97; 0.95–0.99) were significantly associated in the multiple regression. The probability to have multiple counting of hip fracture events varied significantly with age, region, and calendar year. It should be discussed that analyses which do not account for this may provide invalid estimates and conclusions when differences between age groups and regions or trends are analyzed. Einige Studien zur Schätzung der Hüftfrakturinzidenz, ihrer Prädiktoren und Trends basieren auf Analysen der Krankenhausdiagnosestatistik. Diese Datenquelle liefert jedoch keine patientenbezogenen Daten, so dass zum Beispiel Verlegungen oder Wiederaufnahmen nicht als Doppelregistrierungen identifiziert werden können. Unterscheiden sich Doppelregistrierungen nach Alter, Geschlecht, Region und Zeit, kann das zu Verzerrungen der Schätzung führen. Ziel unserer Studie war es, das Ausmaß von Mehrfachregistrierungen und insbesondere die Unterschiede nach Alter, Geschlecht, Region und Kalenderjahr abzuschätzen. Wir nutzten Daten einer bundesweiten gesetzlichen Krankenkasse (1,6 Millionen Mitglieder). Für die Jahre 1998–2009 werteten wir alle Hüftfrakturen (ICD 9: 820, ICD 10: S.72,0–2) von Patienten über 50 Jahre und älter aus und schätzten die Zahl der „ersten Hüftfrakturen“ in jedem Kalenderjahr. Unter Nutzung multipler logistischer Regressionen schätzten wir den Einfluss von Alter, Geschlecht, Region und Kalenderjahr. Die Wahrscheinlichkeiten einer „ersten Fraktur“ pro Patient und Jahr variierten zwischen 86,7 % (95 % Konfidenzintervall 83,9–89,2 %, Jahr 2003) und 93,9 % (90,9–96,2, Jahr 1998). Alter (odds ratio pro 5 Jahren 0,89; 95 % CI 0,86–0,92), Region (Ost- vs. Westdeutschland: 0,65; 0,52–0,81) und Kalenderjahr (pro Jahr 0,97; 0,95–0,99) waren in der multiplen Regression signifikant assoziiert. Die Wahrscheinlichkeit, Hüftfrakturen mehrfach zu registrieren, variierte signifikant mit Alter, Region und Kalenderjahr. Es ist zu diskutieren, dass Analysen, die dies nicht berücksichtigen, falsche Schätzungen und Schlussfolgerungen hinsichtlich der analysierten Unterschiede zwischen Altersgruppen und Regionen oder Trends liefern.
    Keywords: Epidemiology ; Hip fracture ; Incidence trends ; Correction factor ; Bias
    ISSN: 0043-5325
    E-ISSN: 1613-7671
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  • 3
    Language: English
    In: Innovative surgical sciences, December 2016, Vol.1(2), pp.65-71
    Description: Demographic changes confront clinicians with an increasing number of orthogeriatric patients. These patients present with comorbidities, which force their surgeons to take into consideration their medical condition. A major risk factor for fractures in orthogeriatric patients is osteoporosis in combination with frailty. To prevent subsequent fractures in these patients, we need to pay attention to adequate osteoporosis treatment in orthogeriatric patients. There is a huge treatment gap. In Germany, 77% of patients with osteoporosis are not treated adequately. Even after fragility fractures, a low percentage of patients receive a specific osteoporosis therapy. Secondary prevention is of great importance in the treatment of these patients. Diagnostics and treatment should be already initiated with the admission to the hospital. Treatment decisions need to be made individually based on the risk profile of the patients. After discharge, it is important to involve the patients' general practitioners and to follow up on patients regularly to improve their compliance and to ensure adequate therapy. Establishing a fracture liaison service helps coordinating osteoporosis treatment during hospitalization and after discharge. Subsequent fractures can be reduced; therefore, it is an effective service for secondary prevention. The present article provides an overview of how an efficient identification and subsequent treatment of osteoporosis can be achieved in aged trauma patients.
    Keywords: Fracture Liaison Service ; Hip Fracture ; Orthogeriatric ; Osteoporosis ; Vitamin D
    E-ISSN: 2364-7485
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  • 4
    Language: English
    In: Journal of Orthopaedic Surgery and Research, 01 June 2017, Vol.12(1), pp.1-12
    Description: Abstract Background Osteoporosis-associated fractures are of increasing importance in trauma surgery. Systematic diagnostics and treatment of osteoporosis during a hospital stay, however, remain inadequate. Therefore, a specific algorithm for diagnosing and treating osteoporosis in trauma surgery patients was developed based on the DVO (German Osteology Society) guideline for osteoporosis from 2014. Methods In a first step, the individuals’ age and risk profile for osteoporosis is identified considering specific fractures indicating osteoporosis and risk factors assessed by a specific questionnaire. In addition, physical activity, risk of falls, dietary habits and the individuals’ medication are considered. Basic osteoporosis laboratory tests, a bone densitometry by dual-energy X-ray absorptiometry (DXA) and, if needed, X-rays of the spine are carried out to identify prevalent vertebral body fractures. Results Based on the treatment algorithm adapted to the new guidelines for osteoporosis in the majority of proximal femoral fractures, treatment of osteoporosis could already be indicated without prior DXA. In case of preexisting glucocorticoid therapy, a history of previous fractures or other risk factors according to the risk questionnaire, the threshold of treatment has to be adjusted given the table of T-scores. Conclusions The treatment algorithm for diagnosing and treating osteoporosis in in-patient trauma surgery patients can help identify high-risk patients systematically and efficiently. As a result, osteoporosis-associated fractures or failure of osteosynthesis could be reduced, yet a prospective validation of the algorithm has to be completed.
    Keywords: Fragility Fractures ; Hip Fractures ; Orthogeriatrics ; Osteoporosis ; Treatment Algorithm
    E-ISSN: 1749-799X
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  • 5
    Language: English
    In: Bone, 2010, Vol.46, pp.S44-S44
    Keywords: Medicine ; Anatomy & Physiology
    ISSN: 8756-3282
    E-ISSN: 1873-2763
    Source: ScienceDirect Journals (Elsevier)
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  • 6
    In: Wound Repair and Regeneration, September 2011, Vol.19(5), pp.597-607
    Description: The pathophysiology leading to delayed wound healing is complex and efficient therapeutic approaches for accelerated wound healing currently do not exist. We developed a novel drug‐eluting platform for the potential use in wound dressings. Here, we report on the potential of eluting ascorbic acid‐2‐phosphate (‐2), a highly stable variant of ascorbic acid, to induce angiogenesis and to promote collagen synthesis by fibroblasts. The drug‐eluting platform device () consists of biocompatible polymeric layers comprising polyethylene terephtalate, polyvinyl alcohol (), and polyurethane with as the solvent for ‐2. The angiogenic potential of ‐2 was evaluated in the endothelial cell tube formation assay () and in the chorion allantoic membrane () model. Collagen synthesis by ‐2‐stimulated fibroblasts was determined by irius ed staining. ‐2 significantly induced angiogenesis in five independent and assays and induced collagen synthesis in two different fibroblast cell lines. The eluting kinetics of ‐2 was determined by the ultraviolet anorop method and the functional 2,2′‐Azinobis‐(3‐ethylbenzthiazolin‐6‐sulfonic acid) method. Eluting profiles showed a continuous release in the range of biologically effective concentrations 〉10 days. This is the first report showing the proangiogenic‐ and collagen‐promoting features of ‐2. loaded with ‐2 ought to be further evaluated as wound dressings or as supplementary pads for topical treatment of delayed wound healing in preclinical studies.
    Keywords: Drug Delivery Systems ; Angiogenesis Inducing Agents -- Pharmacology ; Ascorbic Acid -- Analogs & Derivatives ; Neovascularization, Physiologic -- Drug Effects ; Wound Healing -- Drug Effects;
    ISSN: 1067-1927
    E-ISSN: 1524-475X
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  • 7
    Language: English
    In: Molecular and Cellular Endocrinology, 26 February 2012, Vol.349(2), pp.180-188
    Description: ► It is unclear whether fat mass increases bone density only by the higher weight. ► We investigate the role of adipocytes as an endocrine tissue in this context. ► Adipocyte-secreted factors include bFGF. ► These factors increase preosteoblast proliferation and OPG/RANKL ratio. ► These findings may represent an endocrine effect of adipocytes on osteoblasts. Several studies have reported a positive relationship of the body fat mass and bone density. However, it is not clear whether adipocyte-derived signaling molecules directly act on osteoblasts or osteoclasts. Therefore, we investigated the effect of fat cell-secreted factors on the proliferation and differentiation of preosteoblasts and the molecular mechanisms involved. This stimulation led to an increased proliferation of MC3T3-E1 and primary preosteoblastic cells (2.8-fold and 1.5-fold, respectively; 〈 0.0001), which could be reduced with inhibitors of protein tyrosine kinases, FGFR1 and PI3K. Concordantly, we found human adipocytes to secrete bFGF and bFGF to mimic the effect of adipocyte-secreted factors. The ratio of OPG/RANKL secretion in primary human preosteoblasts increased 9-fold (mRNA and protein) when stimulated with adipocyte-secreted factors. Moreover, osteoblasts which were prestimulated with adipocyte-secreted factors inhibited the formation of osteoclasts. In conclusion, human adipocytes secrete factors that directly act on preosteoblasts and alter their crosstalk with osteoclasts. These findings reflect the higher bone mass in obese people and attribute it to effects of adipocyte-secreted factors on bone formation.
    Keywords: Aadipocytes ; Osteoblasts ; Osteoporosis ; Obesity ; Bfgf ; Opg/Rankl Ratio ; Medicine ; Anatomy & Physiology
    ISSN: 0303-7207
    E-ISSN: 1872-8057
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  • 8
    Language: English
    Description: Background: Osteoporosis-associated fractures are of increasing importance in trauma surgery. Systematic diagnostics and treatment of osteoporosis during a hospital stay, however, remain inadequate. Therefore, a specific algorithm for diagnosing and treating osteoporosis in trauma surgery patients was developed based on the DVO (German Osteology Society) guideline for osteoporosis from 2014. Methods: In a first step, the individuals' age and risk profile for osteoporosis is identified considering specific fractures indicating osteoporosis and risk factors assessed by a specific questionnaire. In addition, physical activity, risk of falls, dietary habits and the individuals' medication are considered. Basic osteoporosis laboratory tests, a bone densitometry by dual-energy X-ray absorptiometry (DXA) and, if needed, X-rays of the spine are carried out to identify prevalent vertebral body fractures. Results: Based on the treatment algorithm adapted to the new guidelines for osteoporosis in the majority of proximal femoral fractures, treatment of osteoporosis could already be indicated without prior DXA. In case of preexisting glucocorticoid therapy, a history of previous fractures or other risk factors according to the risk questionnaire, the threshold of treatment has to be adjusted given the table of T-scores. Conclusions: The treatment algorithm for diagnosing and treating osteoporosis in in-patient trauma surgery patients can help identify high-risk patients systematically and efficiently. As a result, osteoporosis-associated fractures or failure of osteosynthesis could be reduced, yet a prospective validation of the algorithm has to be completed.
    Source: Open Access LMU (Universitätsbibliothek der LMU München)
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  • 9
    Language: German
    In: Medizinische Klinik, 2006, Vol.101, pp.6-14
    Description: Bisphosphonate sind eine Gruppe osteotroper Substanzen, die in den letzten 30 Jahren erfolgreich bei verschiedenen Knochenerkrankungen eingesetzt werden. Seit über einer Dekade sind Bisphosphonate in oraler Form als etablierte Therapieoption der Osteoporose verfügbar und zugelassen. Die Entwicklung neuer, potenter oraler und parenteraler Bisphosphonate ermöglichte den breiten Einsatz dieser Substanzen in der Onkologie, Hämatologie und Osteologie. Sowohl im Hinblick auf die hochwirksame Therapie der Osteoporose als auch in adjuvanten Therapieansätzen oder zur Schmerztherapie sind die Bisphosphonate innovativ und stellen einen Durchbruch vor allem in der Behandlung der Osteoporose und metabolischer Osteopathien dar. In the last 30 years bisphosphonates have been used in the treatment of different bone diseases. Bisphosphonates in their oral pharmaceutical form are an established and approved medication in osteoporosis treatment for years. Latest research developed more potent bisphosphonates in different application forms: oral and parenteral. Therefore, their prospects for medical treatment could be enlarged to the fields of oncology, hematology, and osteology. Bisphosphonates are innovative in case of adjuvant therapy as well as in adequate pain therapy. In the medical treatment of osteoporosis and metabolic osteopathies bisphosphonates could be rightly denoted as groundbreaking.
    Keywords: Bisphosphonates ; Osteoporosis ; Metabolic osteopathies
    ISSN: 0723-5003
    E-ISSN: 1615-6722
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  • 10
    Language: German
    In: Notfall & Hausarztmedizin, 2006, Vol.32(6), pp.298-303
    Description: Typisch für den osteoporotischen Rückenschmerz ist sein plötzliches, schlagartiges Einsetzen infolge von Frakturen der Wirbelkörper. Vor Einleitung einer Schmerztherapie sollte eine ausführliche Schmerzanamnese erfolgen, die die Beschreibung von Dauer, Intensität, Charakter, Lokalisation, Ausstrahlung und gegebenenfalls zeitlichem Muster erfasst. Die Sofortbehandlung des akuten Schmerzes erfolgt durch peripher wirksame Analgetika, die bei sehr starken Schmerzen - beispielsweise bei frischen Frakturen - mit einem schwachen Opioid kombiniert werden. Im Vordergrund der Behandlung chronischer Schmerzen steht die physikalische Therapie und nachfolgend die zunehmende Mobilisierung des Patienten unter entsprechender Analgesie. Weitere Maßnahmen sind die Bisphosphonattherapie und in einzelnen Fällen auch die perkutane transpedikuläre Injektion von Knochenzement in die Wirbelkörper (Vertebro- oder Kyphoplastie). Ist eine ausreichende Stabilisierung der osteoporotisch bedingten Wirbelkörperfrakturen sowie ausreichende Analgesie mittels Schmerz- und Osteoporose-Therapie erreicht, erfolgt die intensive physiotherapeutische Betreuung beziehungsweise Mobilisierung der Patienten.
    Description: The Onset of Osteoporotic back pain is typically sudden, due to fracture of vertebrae. Before analgesia is implemented, a detailed history of pain should be obtained, including a description of duration, intensity, character, localisation, radiation and possibly its pattern over time. Immediate treatment of acute pain is implemented with a peripherally effective analgesic, which in the case of severe pain - as is, for example, associated with a fresh fracture - is combined with a mild opioid. A predominant aspect of the treatment of chronic pain is physiotherapy followed by gradually increasing mobilization of the patient on appropriate analgesia. Further options are treatment with bisphonates and, in individual cases, percutaneous transpedicular injection of bone cement into the vertebral body (vertebroplasty or kyphoplasty). When adequate stabilization of the osteoporotic fracture(s) and appropriate analgesia with pain and osteoporosis treatment has been achieved, intensive physiotherapeutic measures or mobilisation is initiated.
    ISSN: 1612-8583
    E-ISSN: 1612-8605
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