The reason for such differences is still unclear and, thus, the consequences of urbanization must be considered to explain diverse incidence rates. In general, the investigation of causes should be based on the use of a multivariate model that takes additional factors such as specific drug use, socioeconomic aspects, environmental aspects, education, and health care into account. There are large regional differences in the incidence of hip fracture in Germany. These differences were unexpected and do not follow a north-to-south or an east-to-west gradient. But they are of high socioeconomic importance and cannot be explained by geographic location, the age structure of the population and only to a small extent by the regulation of specific medication.

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.

To ensure a successful application of the recommendations, continuous support of involved health professionals as well as political institutions, national health insurance systems, scientific societies and patient organisations is necessary.

ZusammenfassungDie Gründung von interdisziplinären Qualitätszirkeln Osteoporose erfolgte zur Verbesserung der Versorgung von Patientinnen und Patienten mit Osteoporose. Neben der Verbesserung der Versorgungsqualität war es uns ein wichtiges Anliegen, eine einheitliche Dokumentation zu entwickeln, um die Möglichkeit zu schaffen, die Qualität der Versorgung auch zu evaluieren. Neben der Idee zur Versorgungsforschung stand aber auch die Forderung der zertifizierten Osteologen DVO im Raum, in Versorgungsverträge mit der gesetzlichen Krankenversicherung einzutreten. Die dazu notwendige juristische Voraussetzung wurde mit der Gründung des Bundes der Osteologen als eingetragener Verein geschaffen.Im Ergebnis dieser Entwicklung hat sich die Betreuungsqualität von Patientinnen und Patienten mit Osteoporose deutlich verbessert.

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.