Osteoporosis in the Context of Medial Expert Evidence

Abstract

Due to its high prevalence und sometimes serious medical consequences, osteoporosis is of highest socio-economic importance. Medical experts are confronted with it in a wide variety of fields of law. In order to be able to correctly classify the disease in the respective legal framework, current knowledge about it is required. Important classifications as well as scientifically determined findings on fractures and fracture healing are in the foreground. This knowledge can be used to answer questions concerning prevention, reduced earning capacity, incapacity for work, context assessments or restrictions according to the social compensation law or the severely disabled law.

Key words

osteoporosis - assessment - musculoskeletal expert assessment - fragility fracture

Publication History

Article published online:
21 October 2019

• References/Literatur

• 1 Consensus development conference: diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 1993; 94: 646-650
• 2 Consensus Development Conference. Prevention and Therapy of Osteoporosis. EFFO/NOF, 19.–23.05.1996, Amsterdam.
• 3 Schiltenwolf M, Hollo D. Begutachtung der Haltungs- und Bewegungsorgane. 6. Aufl.. Stuttgart: Thieme; 2013
• 4 Weise K, Schiltenwolf M. Grundkurs orthopädisch-unfallchirurgische Begutachtung. 2. Aufl.. Berlin, Heidelberg: Springer; 2014
• 5 Kanis JA. WHO Technical Report. 2007. UK: University of Sheffield; 2007: p66
• 6 Hadji P, Klein S, Gothe H. et al. The epidemiology of osteoporosis – Bone Evaluation Study (BEST): an analysis of routine health insurance data. Dtsch Arztebl Int 2013; 110: 52-57
• 7 Puth MT, Klaschik M, Schmid M. et al. Prevalence and comorbidity of osteoporosis – a cross-sectional analysis on 10,660 adults aged 50 years and older in Germany. BMC Musculoskelet Disord 2018; 19: 144
• 8 International Osteoporosis Foundation. Facts and statistics. Im Internet (Stand: 26.03.2019): http://www.iofbonehealth.org/facts-statistics
• 9 Fuchs J, Scheidt-Nave C, Kuhnert R. 12-Monats-Prävalenz von Osteoporose in Deutschland. J Health Monit 2017; 2: 61-65
• 10 Pisani P, Renna MD, Conversano F. et al. Major osteoporotic fragility fractures: Risk factor updates and societal impact. World J Orthop 2016; 7: 171-181
• 11 Resch H, Zendeli A, Laimer N. Osteoporose, eine Volkskrankheit – Diagnostik und Therapie. J Miner Stoffwechs Muskuloskelet Erkrank 2018;
• 12 Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet 2019; 393: 364-376
• 13 Anil G, Guglielmi G, Peh WCG. Radiology of osteoporosis. Radiol Clin North Am 2010; 48: 497-518
• 14 [Anonymous] Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 1994; 843: 1-129
• 15 Klemm HT, Albers W, Krumbiegel A. et al. [Osteoporosis in private accident insurance]. Unfallchirurg 2018; 121: 83-88
• 16 Pfeifer M, Pollähne W, Minne HW. Begutachtung bei Osteoporose: Befunde – Kriterien – Beurteilung. Orthopädie & Rheuma 2003; 2: 18-19
• 17 Stone KL, Seeley DG, Lui LY. et al. BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res 2003; 18: 1947-1954
• 18 Marshall D, Johnell O, Wedel J. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996; 312: 1254-1259
• 19 Johnell O, Kanis JA, Oden A. et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res 2005; 20: 1185-1194
• 20 Burt LA, Manske SL, Hanley DA. et al. Lower bone density, impaired microarchitecture, and strength predict future fragility fracture in postmenopausal women: 5-year follow-up of the Calgary CaMos cohort. J Bone Miner Res 2018; 33: 589-597
• 21 Cranney A, Jamal SA, Tsang JF. et al. Low bone mineral density and fracture burden in postmenopausal women. Can Med Assoc J 2007; 177: 575-580
• 22 Rubin KH, Friis-Holmberg T, Hermann AP. et al. Risk assessment tools to identify women with increased risk of osteoporotic fracture: complexity or simplicity? A systematic review. J Bone Miner Res 2013; 28: 1701-1717
• 23 ClinRisk. Welcome to the QRISK®3–2018 risk calculator. Im Internet (Stand:26.03.2019): https://qrisk.org/three
• 24 Garvan Institute of Medical Research. Fracture Risk Calculator. Im Internet (Stand:26.03.2019): https://www.garvan.org.au/promotions/bone-fracture-risk/calculator/
• 25 University of Sheffield. Fracture Risk Assessment Tool. Im Internet (Stand: 26.03.2019): https://www.sheffield.ac.uk/FRAX/tool.aspx?country=9
• 26 DVO (Dachverband der Deutschsprachigen Wissenschaftlichen Osteologischen Gesellschaft e.V.). Prophylaxe, Diagnostik und Therapie der Osteoporose. 2017. Im Internet (Stand: 12.08.2019): https://www.dv-osteologie.org/uploads/Leitlinie%202017/Finale Version Leitlinie Osteoporose 2017_end.pdf
• 27 Weber K. [Expert assessment in cases of osteoporosis]. Z Rheumatol 2007; 66: 488-492
• 28 Center JR, Bliuc D, Nguyen TV. et al. Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 2007; 297: 387-394
• 29 Torgerson DJ, Campbell MK, Thomas RE. et al. Prediction of perimenopausal fractures by bone mineral density and other risk factors. J Bone Miner Res 1996; 11: 293-297
• 30 Bonafede M, Shi N, Barron R. et al. Predicting imminent risk for fracture in patients aged 50 or older with osteoporosis using us claims data. Arch Osteoporos 2016; 11: 26
• 31 Pongchaiyakul C, Nguyen ND, Jones G. et al. Asymptomatic vertebral deformity as a major risk factor for subsequent fractures and mortality: a long-term prospective study. J Bone Miner Res 2005; 20: 1349-1355
• 32 Roux C, Briot K. Imminent fracture risk. Osteoporos Int 2017; 28: 1765-1769
• 33 Ismail AA, OʼNeill TW, Cockerill W. et al. Validity of self-report of fractures: results from a prospective study in men and women across Europe. EPOS Study Group. European Prospective Osteoporosis Study Group. Osteoporos Int 2000; 11: 248-254
• 34 Ensrud KE, Blackwell TL, Fink HA. et al. What proportion of incident radiographic vertebral fractures in older men is clinically diagnosed and vice versa: a prospective study. J Bone Miner Res 2016; 31: 1500-1503
• 35 Hak DJ. The biology of fracture healing in osteoporosis and in the presence of anti-osteoporotic drugs. Injury 2018; 49: 1461-1465
• 36 Ahmed ASI, Sheng MH, Wasnik S. et al. Effect of aging on stem cells. World J Exp Med 2017; 7: 1-10
• 37 Gruber R, Koch H, Doll BA. et al. Fracture healing in the elderly patient. Exp Gerontol 2006; 41: 1080-1093
• 38 Nikolaou VS, Efstathopoulos N, Kontakis G. et al. The influence of osteoporosis in femoral fracture healing time. Injury 2009; 40: 663-668
• 39 Barrios C, Broström LA, Stark A. et al. Healing complications after internal fixation of trochanteric hip fractures: the prognostic value of osteoporosis. J Orthop Trauma 1991; 7: 438-442
• 40 Andreen O, Larsson SE. Effects of parathyroidectomy and vitamin D on fracture healing. Fracture biomechanics in rats after parathyroidectomy and treatment with 1,25-dihydroxycholecalciferol. Acta Orthop Scand 1983; 54: 805-809
• 41 Neidlinger-Wilke C, Stalla I, Claes L. et al. Human osteoblasts from younger normal and osteoporotic donors show differences in proliferation and TGF beta-release in response to cyclic strain. J Biomech 1995; 28: 1411-1418
• 42 Nicolas V, Prewett A, Bettica P. et al. Age-related decreases in insulin-like growth factor-I and transforming growth factor-beta in femoral cortical bone from both men and women: implications for bone loss with aging. J Clin Endocrinol Metab 1994; 78: 1011-1016
• 43 Reed MJ, Edelberg JM. Impaired angiogenesis in the aged. Sci Aging Knowledge Environ 2004; 2004: pe7 doi:10.1126/sageke.2004.7.pe7
• 44 Rodriguez JP, Garat S, Gajardo H. et al. Abnormal osteogenesis in osteoporotic patients is reflected by altered mesenchymal stem cells dynamics. J Cell Biochem 1999; 75: 414-423
• 45 Cummings SR, Black DM, Nevitt MC. et al. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet 1993; 341: 72-75
• 46 Hui SL, Slemenda CW, Johnston CC. Baseline measurement of bone mass predicts fracture in white women. Ann Intern Med 1989; 111: 355-361
• 47 Schröter F. Gutachtliche Problemstellungen bei Osteoporose. Med Sach 2006; 102: 212-217
• 48 Schönberger A, Merthens G, Valentin H. Arbeitsunfall und Berufskrankheit. Rechtliche und medizinische Grundlagen für Gutachter, Sozialverwaltung, Berater und Gerichte. 9. Aufl.. Berlin: Erich Schmidt; 2016
• 49 Nguyen TV. Individualized fracture risk assessment: state-of-the-art and room for improvement. Osteoporos Sarcopenia 2018; 4: 2-10
• 50 Crandall CJ, Larson J, LaCroix A. et al. Predicting fracture risk in younger postmenopausal women: comparison of the Garvan and FRAX risk calculators in the womenʼs health initiative study. J Gen Intern Med 2019; 34: 235-242