Austrian Osteoporosis Report: epidemiology, lifestyle factors, public health strategies.

The first Austrian Osteoporosis Report was initiated to create a comprehensive reference document for the pathogenesis, diagnostics, therapy, and rehabilitation of osteoporosis. Furthermore, the aim was to present the extent and severity of osteoporosis and the associated complications in Austria. On the basis of current international prevalence, it can be estimated that approximately 740,000 of people in Austria over 50 years are affected by osteoporosis, of whom around 617,000 are women. A special analysis of the hospital discharge statistics showed that, in the year 2005, 1382 men and 8080 women were discharged from Austrian hospitals with the main diagnosis, osteoporosis. Added to these 9711 male cases and 54,840 females cases were documented with osteoporosis as a secondary diagnosis. In Austria around 16,500 people suffer a hip fracture each year. Thus, with a fracture rate of 19.7 fractures per year per 10,000 inhabitants over the age of 65 years, Austria lies within the peak for Europe. The hospital mortality rate amongst patients with fracture of the femur is 3.8% in men and 3.2% in women in Austria. Everybody's bone health can be positively influenced by a healthy lifestyle; however, the Osteoporoses Report revealed insufficiencies regarding lifestyle risk factors in the Austrian population. Average calcium intake amongst Austrian adult women and amongst male and female seniors is lower than recommended and only adult men achieve around the recommended amount. The mean vitamin D intake in Austria is very poor, especially amongst pre-schoolers and seniors. The rate of Austrians reporting regular physical exercise is in need of improvement, especially amongst elderly people. The data presented in the Austrian Osteoporosis Report are useful to enable the development of public health strategies and methods to help resolve some of these problems, and ultimately contribute to improved bone health in the nation.

[Economic concepts for measuring the costs of illness of osteoporosis: an international comparison]. / Okonomische Konzepte zur Erfassung der Krankheitskosten von Osteoporose: Osterreich im internationalen Vergleich.

Worldwide osteoporosis is underestimated and despite availability of effective and cost effective treatments, these are often not implemented. Apart from a demographically driven increase in disease cases, failure to implement or tardy implementation of preventive measures as well as poor treatment compliance leads to a deterioration of the health economic outcomes. This in turn causes considerable costs to the health care system and to society, through ineffective intake of medication, diminished quality of life and inability to work as well as substantial costs of rehabilitation of patients. Health economic analyses and methods are increasingly used by decision makers to set priorities and evaluate alternative treatment measures about their cost-effectiveness. In order to be able to capture the costs of illness incurred by osteoporosis, different diseases specific models and methods have been developed, such as the reference model of the IOF, an osteoporosis-specific Markov model or internationally comparable intervention thresholds. Health economists estimate that osteoporosis-related costs will double by 2050 in both Europe and the individual countries. For Europe this means an increase from 40 billion Euro in 2000 to almost 80 billion Euro in 2050. In Austria, an aggregation of the different costs of osteoporosis is not possible, due to a lack of comparability and availability of data. The international ICUROS study and the Austrian Osteoporosis Report 2007 are the first steps towards counteracting this situation.

Integrated care at the crossroads-defining the way forward.

INTRODUCTION AND BACKGROUND: The non-existence of a common terminology or standards in Integrated Care makes it difficult to compare experiences and results, whether on a national or international level, while the interdisciplinarity of the concept, both in theory and practice, proves to be a curse when it should be a blessing. Thus, we found it high time to bridge the gap, bring practice to theory and discuss the pressing issues of future Integrated Care research. WORKSHOP REPORT: DURING THE EXPERT WORKSHOP, DISCUSSIONS WERE HELD CONCERNING FOUR OVERARCHING TOPICS: (1) defining the common base for integrated care, evaluation and quality; (2) discussion on methods and tools, healthy environs; (3) governing and managerial prerequisites for integrated care and the future of integrated care; and (4) research questions arising from the workshop. The results were formulated into actions and research questions for the future. DISCUSSION: The workshop proved the necessity of consolidation in the area in order to foment the concept. Researchers should improve coordination and cooperation among themselves and draw from the various fields which deal with similar questions. CONCLUSION: It remains to be seen whether integrated care manages to grow out of its baby shoes and establish itself as an independent and interdisciplinary field of research.