DÄ internationalArchive3/2009The Diagnosis and Treatment of Primary Osteoporosis According to Current Guidelines: Back Orthoses are Important

Correspondence

The Diagnosis and Treatment of Primary Osteoporosis According to Current Guidelines: Back Orthoses are Important

Dtsch Arztebl Int 2009; 106(3): 38. DOI: 10.3238/arztebl.2009.0038a

Pfeifer, M

LNSLNS The authors have successfully tackled a complex and difficult subject in a very compact format. However, we wish to correct some minor inaccuracies. On page 578, in the bottom left paragraph, they say: "Directed exercise programs can, at least, reduce the risk of falling, although the studies performed to date have included too few patients to demonstrate any resulting reduction of the fracture rate. Because fractures are relatively rare events, very large studies would be needed to demonstrate this." This statement cannot remain unchallenged: Kaptoge et al showed unequivocally in a prospective, population based, European wide study that in 2103 men and 2565 women, the event of a fall is of much greater importance for the development of an osteoporosis related fracture than, for example, reduced bone density (1). This has also been confirmed by a study of 2649 postmenopausal women, reported by Geusens et al (2).

Further, the authors omitted to mention the importance of back ortheses in the treatment of acute and chronic pain. The DVO guidelines of 2006 say: "After fractures, mobilization should be undertaken as soon as possible. To minimize pain, a spine stabilizing orthesis (...) is available (...) among others." Further, the authors say that in patients with chronic pain "(...) orthetic measures are helpful in stabilizing the posture and reducing pain. In addition to the acute fracture event, ortheses that exercise the muscles in the back are the preferred option." DOI: 10.3238/arztebl.2009.0038a


Dr. med. Michael Pfeifer
Prof. Dr. med. Helmut W. Minne
Institut für klinische Osteologie Gustav Pommer und Klinik
„DER FÜRSTENHOF“
Am Hylligen Born 7
31812 Bad Pyrmont, Germany
iko_pyrmont@t-online.de

Conflict of interest statement
The authors declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
Kaptoge S, Benevolenskaya LI, Bhalla AK et al.: Low BMD is less predictive than reported falls for future limb fractures in women across Europe: results from the European Prospective Osteoporosis Study. Bone 2006; 38: 145–9. MEDLINE
2.
Geusens P, Autier P, Boonen S, Vanhoof J, Declerck K, Raus J: The relationship among history of falls, osteoporosis, and fractures in postmenopausal women. Arch Phys Med Rehabil 83: 903–6. MEDLINE
3.
Pfeifer M, Begerow B, Minne HW. Effects of a new spinal orthosis on posture, trunk strength and quality of life in women with postmenopausal osteoporosis. Am J Phys Med Rehabil 2004; 83: 177–86. MEDLINE
1. Kaptoge S, Benevolenskaya LI, Bhalla AK et al.: Low BMD is less predictive than reported falls for future limb fractures in women across Europe: results from the European Prospective Osteoporosis Study. Bone 2006; 38: 145–9. MEDLINE
2. Geusens P, Autier P, Boonen S, Vanhoof J, Declerck K, Raus J: The relationship among history of falls, osteoporosis, and fractures in postmenopausal women. Arch Phys Med Rehabil 83: 903–6. MEDLINE
3. Pfeifer M, Begerow B, Minne HW. Effects of a new spinal orthosis on posture, trunk strength and quality of life in women with postmenopausal osteoporosis. Am J Phys Med Rehabil 2004; 83: 177–86. MEDLINE