LNSLNS

We wish to comment on Schneider’s appropriate and constructive criticisms. The WHO definition of osteoporosis that we chose for our article is still valid—in our article, we pointed out that the fracture risk depends on several risk factors; these obviously include people’s civilization-related physical inactivity, as Schneider mentioned. For this reason we mentioned the DVO’s S3 guidelines on several occasions, which determine the absolute fracture risk through a combination of age, prevalent fractures, further risk factors, and bone density. These S3 guidelines are generally accepted and implemented in Germany and make a great contribution to realistically determining the individual fracture risk. As Schneider is aware, the guideline group decided—for a number of relevant reasons—against adopting the FRAX risk score in its guideline update in 2009 and in the current draft guideline 2013. We are not able to relate to the overestimate of risk factors as pointed out by Schneider, such as the effect of thyroid-stimulating hormone (TSH) or aromatase inhibitors, in the DVO guidelines. The guideline procedures (including source materials) are transparently explained on the internet. Furthermore, these recommendations are consistent with the S3 guidelines of the breast section in the Arbeitsgemeinschaft Gynäkologischer Onkologie (AGO, the working group for gynecological oncology).

In conclusion, we thank our correspondent for his constructive ideas, but for the reasons just explained we do not see any reason to distance ourselves from our study results and from the conclusions drawn.

DOI: 10.3238/arztebl.2013.0401b

On behalf of the authors

Prof. Dr. med. Peyman Hadji
Universitätsklinikum Gießen und Marburg

Silvia Klein
IGES Institut, Berlin
silvia.klein@iges.de

Conflict of interest statement

Professor Hadji works at the Philipps-Universität in Marburg, Germany, and at the Universitätsklinikum Gießen und Marburg GmbH. He has received lecture honoraria and research support from Amgen, Eli Lilly, GSK, Novartis, Nycomed, Pfizer, Procter and Gamble, and Roche. He and Silvia Klein have worked on projects financed by AMGEN and Nycomed.

1.
Hadji P, Klein S, Gothe H, Häussler B, Kless T, Schmidt T, Steinle T, Verheyen F,
Linder R: The epidemiology of osteoporosis—Bone Evaluation Study (BEST):
an analysis of routine health insurance data. Dtsch Arztebl Int 2013; 110(4): 52–7. VOLLTEXT
1. Hadji P, Klein S, Gothe H, Häussler B, Kless T, Schmidt T, Steinle T, Verheyen F,
Linder R: The epidemiology of osteoporosis—Bone Evaluation Study (BEST):
an analysis of routine health insurance data. Dtsch Arztebl Int 2013; 110(4): 52–7. VOLLTEXT

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