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Background: Vertebral and pelvic fractures are associated with a significant burden of negative health and psychosocial outcomes. The number of vertebral and pelvic fractures is increasing in an aging society. Vertebral and pelvic fractures are increasingly significant injuries for individuals and society. However, few epidemiological studies have examined the clinical course of vertebral and pelvic fractures. This is the protocol for a study that observes patients who have been admitted to the hospital with an incident vertebral or pelvic fracture for a period of 12 months. Methods: The observational cohort study is conducted at three study sites in Germany. Patients affected by vertebral or pelvic fractures are recruited within the first few days of hospital admission. Data collection takes place at four-time points: baseline, before discharge, after 4 months, and after 12 months after admission to the hospital. Particular emphasis is laid on the assessment of the fall mechanisms, physical function, physical activity, life space, mobility, treatment approach, and quality of life. The hospital stay involves the collection of biomaterials (blood and urine). Discussion: The study aims to enhance understanding of the clinical progression and outcomes in patients with fractures in the vertebrae or pelvis. [ABSTRACT FROM AUTHOR]

• An orthogeriatric co-management of fragility fractures increases prescription rates of anti-osteoporotic drugs after hospital discharge. • Prescription rates are particularly high if these hospitals are additionally certified as ‚geriatric trauma center'. • This prescription pattern was found for fractures of the humerus, hip, pelvis and spine, in men and women, and in all age categories. Geriatricians are increasingly involved in the treatment of fragility fractures. In Germany, hospitals that meet specific standards for orthogeriatric co-management (OGCM) are additionally certified as 'geriatric trauma centers.' One responsibility of OGCM is the appropriate management of osteoporosis through medication. We aimed to analyse the association between prescription frequencies of anti-osteoporotic drugs in hospitals with certified OGCM, those with non-certified OGCM, and those with no OGCM at all. Claims data from nearly 200,000 patients aged 80 and older with an incident index fracture of the humerus, forearm, hip, pelvis, or spine, were obtained from a German health insurance. Hospitals were categorized into three groups: no OGCM, with OGCM, and with certified OGCM. The outcomes were new prescriptions for specific anti-osteoporotic drugs and vitamin D within 180 days after the index fracture. Crude incidences and adjusted incidence rate ratios (IRR) were calculated. Prescription rates of specific anti-osteoporotic drugs and vitamin D increased from hospitals with no OGCM to hospitals with OGCM and were highest in hospitals with certified OGCM. This pattern was observed across all fracture types, age groups, and both men and women, except for forearm fractures. For example, in hip fractures, the IRR for prescriptions of specific anti-osteoporotic drugs in hospitals with certified OGCM compared to those with no OGCM was 2.17 (95 % CI: 1.90–2.48). OGCM, especially when coupled with certification as a 'Geriatric Trauma Center,' is associated with higher prescription rates of specific anti-osteoporotic drugs and vitamin D after fragility fractures in Germany. [ABSTRACT FROM AUTHOR]

Background: Fractures are a major health problem in aging societies. Preventive approaches combining bone health and fall prevention are rare. The osteoporotic fracture prevention program in rural areas (OFRA) is a health care fund-driven program for older people in randomly selected districts in Germany. The components of the program were falls prevention exercise classes, examination of bone health by a dual-energy X-ray absorptiometry (DXA) scan, and a consultation about "safety in the living environment." The aim of this study was to evaluate this complex preventive intervention in a routine health care setting.Methods: This cluster-randomized trial was performed from October 2015 to October 2018 and took place in 186 administrative districts in five federal states, 47 districts served as intervention districts, and 139, as controls. Within these districts, we included (a) all community-living women and men aged 70-85 years with prior fragility fractures and (b) all community-living women aged 75-80 years. The analysis used routine data collected by a health insurance company. The primary endpoint was all fragility fractures combined. Fracture types, mortality, and nursing home admission were explorative endpoints. Cox frailty models were used for comparative analyses with a median follow-up time of 365 days (interquartile range: 0 days).Results: Nine thousand four hundred eight individuals were approached to participate in one of the program components, 27,318 individuals served as controls. The mean age was 78.7 years. Of those approached to participate, nearly 30% joined the exercise classes. DXA measurement was reimbursed for 13.6%, and 51.8% received advice about measures to increase "safety in the living environment." The incidence of fragility fractures did not differ between the intervention and the control group (HR 0.94; 95% CI 0.80-1.11). However, femoral fractures, the most frequent fracture type, were reduced in the intervention group (HR 0.76; 95% CI 0.59-0.99). Mortality and nursing home admission did not differ between the intervention and the control group.Conclusions: A comprehensive fracture prevention program for older people living in rural areas was implemented. The program did not affect the primary endpoint of all fragility fractures combined. It has to be considered that we used a modified intention to treat approach based on geographic randomization and information about endpoints relied exclusively on routine data of the health care insurance.Trial Registration: German Clinical Trials Register DRKS-ID: 00009000. [ABSTRACT FROM AUTHOR]

Background: Fragility fractures are one of the leading causes of disability in older adults. Yet, evidence for effectiveness and cost-effectiveness of preventive approaches combining bone health and fall prevention is rare. Objective: To conduct a health-economic evaluation of the German osteoporotic fracture prevention program in rural areas (OFRA). Design: Secondary cluster–randomized intervention study based on routine data. Participants: All districts in five federal states in Germany were cluster-randomized as intervention or control districts. OFRA was offered to community-living (a) women aged 75–79 years or (b) women and men aged 70–84 years with a prior fragility fracture in the intervention districts. Individuals who meet these criteria in the control districts were assigned to the control group. Intervention: OFRA comprised mobility and falls prevention classes, examination of bone health by bone density measurement, and consultation on safety in the home living environment. Main Measures: We measured health-care costs and effectiveness in terms of time to fragility fracture or death within 1 year after initial contact, based on health insurance claims data. Implementation costs were recorded by the intervention performers. We calculated an incremental cost-effectiveness ratio (ICER) and employed the net-benefit approach to construct a cost-effectiveness acceptability curve (CEAC). Key Results: There were 9408 individuals in the intervention group and 27,318 in the control group. Mean time to fragility fracture or death (difference: 0.82 days) and health-care costs (difference: 111.73€, p <.01) were reduced, but mean intervention costs (difference: 260.10€) increased total costs (difference: 148.37€, p <.001) in the intervention group. The ICER per fracture-free year of survival was 66,094.63€. The CEAC showed no acceptable probability of cost-effectiveness at a reasonable willingness to pay. Conclusion: OFRA showed reduced rates of fragility fractures, but had high implementation costs, resulting in an unfavorable ICER. The cost-effectiveness of OFRA may improve with a longer follow-up. [ABSTRACT FROM AUTHOR]

Background: Fragility fractures are one of the leading causes for disability in old people. The main underlying mechanisms are osteoporosis and falls. Evidence-based measures to prevent either falls or fractures are available. However, coordinated preventive approaches combining bone health and fall prevention are rare. The objective of the study is to evaluate a health care fund driven program, which encourages insured persons to adhere to national guidelines regarding bone health and physical activity and falls prevention. The health care fund cooperates with the 'German Association of Rural Women' and the 'German Gymnastics Association'. The program consists of mobility and falls prevention classes, the examination of bone health by a DXA scan, and a consultation about 'safety in the living environment'. Methods: Cluster-randomized study in 47 intervention and 143 control districts in 5 federal states of Germany. The program is offered to a) community-living women and men aged 70 to <85 years with a prior fragility fracture or b) community-living women aged 75 to <80 years. Within two years more than 10,000 persons will be directly contacted and motivated to make use of the components of the program. The primary outcome is a combined measure of incident osteoporotic fractures. Secondary outcomes include the rate of referrals to a mobility and falls prevention class or a bone mass density measurement. An economic evaluation will be conducted. Discussion: The study evaluates a complex preventive intervention in a routine health care setting which may serve as model for similar approaches in other areas or countries. [ABSTRACT FROM AUTHOR]

Objective: To investigate variation of care dependency after hip fracture across German regions based on the assessment by the German statutory long-term care insurance. Data sources/study setting: Patient-level statutory health and long-term care insurance claims data from 2009–2011 and official statistical data from Germany. Study design: We performed a retrospective cohort study. Investigated multinomial outcome categories were increase in care dependency (new onset or a higher care dependency than pre-fracture), no change as reference and death as competing risk in the quarterly period following hip fracture (follow-up 3 months). Regional variation was operationalized with the variance of regional-level random intercepts based on generalized linear mixed models. We adjusted for patient and regional characteristics. Principal findings: The study included 122,887 hip fracture patients in 95 German postal code regions. Crude outcomes were 30.87% increase in care dependency and 14.35% death. Results indicated modest variation on regional level. Male sex, increasing age, increasing comorbidity, pertrochanteric and subtrochanteric fracture site compared to femoral neck, time from hospital admission to surgery of 3 or more days, as well as increasing inpatient length of stay, non-participation in rehabilitation and regions with lower hospital density were positively associated with an increase in care dependency. Conclusions: Several characteristics on patient and regional level associated with the outcome were identified. Variation in the increase in care dependency after hip fracture appeared to be attributable primarily to patient characteristics. Variation on regional level was only modest. [ABSTRACT FROM AUTHOR]

Abstract Objectives Hip fractures are common consequences of falls in older adults and, among other negative health outcomes, often lead to care dependence in the long term. Until 2016, the German long-term care insurance classified care recipients according to a standardized classification system consisting of 3 care levels. It was based on required assistance in performing activities of daily living and assessed by a qualified physician or nurse. Thus, care level reflects the degree of care dependence. The aim of this study was to determine relevant patient characteristics, which are related to the likelihood of increasing care dependence in terms of worsening care level after hip fracture. Design Retrospective cohort study. Setting and participants Statutory health insurance claims data including 122,922 insured individuals living in Germany and aged 65 years or older, who sustained a hip fracture from 2009 through 2011. Measures The association of patient characteristics with worsening care level in the quarterly period after hip fracture was investigated by means of multinomial logit regression analysis. Death constitutes a competing risk and was modeled as additional nominal outcome. Results Among all patients, crude rates were 30.9% for worsening care level, 54.8% for unchanged care level, and 14.4% for death after hip fracture. The multivariate analysis revealed that patient factors male sex, increasing age, increasing comorbidity, increasing inpatient length of stay, and a lack of inpatient rehabilitation were significantly associated with a worsening care level. Conclusions/Implications This study uses the German standardized measurement of care dependence in terms of worsening care level after hip fracture and finds various related patient characteristics. Knowledge of these characteristics helps to identify possible risk groups for care dependence after hip fracture, for which special attention can be provided regarding treatment and prevention of hip fractures. [ABSTRACT FROM AUTHOR]