[Osteoporotic treatment options in geriatric patients]. / Therapie der Osteoporose beim geriatrischen Patienten.

Due to the demographic changes of the last few decades, there has been a significant increase in the number of osteoporotic fractures. After a fracture, geriatric patients are at particularly high risk for an increase of their functional impairments as well as a loss of independence and quality of life. In spite of the severe medical and socioeconomic consequences of fragility fractures, osteoporotic treatment and prevention are still insufficient. Based on the current literature, the pharmacological and nonpharmacological treatment options as well as new surgical techniques for geriatric patients are reviewed.

[Management and therapy of atrial fibrillation in geriatric patients]. / Management und Therapie des Vorhofflimmerns beim geriatrischen Patienten.

Among geriatric patients, atrial fibrillation is the most common cardiac arrhythmia. In patients over 80 years of age, the prevalence rises to approximately 10%. Atrial fibrillation is associated with serious health implications, including a 2-fold increase in mortality risk and a 5-fold increase in stroke risk. In contrast to these facts, the current guidelines on the management of atrial fibrillation of the European Society of Cardiology (ESC) contain only a short paragraph on these patients. Many relevant clinical aspects go without any comment. Thus, the purpose of our paper is to discuss those special needs of geriatric patients and their physicians which are not mentioned in the guidelines of the ESC. In our review, we discuss rhythm versus rate control, oral anticoagulation, outcome, prevention, falls, adherence, polypharmacy, dementia, nursing home patients, frailty, and geriatric assessment in consideration of geriatric patients. An extended search of the literature on Pubmed served as the basis for this review. Individual aspects of each geriatric patient should be considered when managing these complex patients; however, the complexity of each case must not lead to an individualized therapy that is not in accordance with current guidelines and the literature. A large number of papers which help us to answer most of the clinical questions regarding the management of trial fibrillation in geriatric patients have already been published.

Treatment of osteoporosis in postmenopausal hip fracture patients after geriatric rehabilitation: changes over the last decade.

BACKGROUND: Osteoporotic hip fractures are a major cause of morbidity and mortality in postmenopausal women, and their impacts on society are substantial. Although adequate osteoporotic treatment reduces the risk of subsequent fractures and also mortality, only a minor proportion of the patients receives sufficient therapy. OBJECTIVES: The goal of the present study was to evaluate osteoporosis treatment in two different cohorts and to describe the changes after the implementation of a Geriatric Facture Center (GFC) in cooperation with a level 1 trauma center. STUDY DESIGN: A retrospective, single-center cross sectional study design was used. METHODS: A total of 455 patients (70 years and older) were included at our department of geriatric medicine. The patients were split into two groups. The usual care (UC) group consisted of 327 patients admitted to our department from 2001-2004. The GFC group included 128 patients admitted from 2009-2010. In addition to recording osteoporosis therapy, we collected demographic data, comorbidities, and different functional parameters of the patients. The data were collected retrospectively using medical records. SPSS 18.0 was used for statistical analysis. RESULTS: Of the patients, 43% in the GFC group received a specific antiresorptive or anabolic treatment (SAAT). Basic treatment with calcium and vitamin D3 was prescribed in 88% of the patients. The diagnosis "osteoporosis" was found in 73.4% of the discharge letters. In the UC group, the percentage of patients with a SAAT was 14.7%, calcium and vitamin D3 was prescribed in 30%, and the diagnosis was documented in 24.5%. All these differences are statistically significant (p < 0.0001). In the GFC group, better functional status and cognition were significantly associated with a higher rate of a prescribed SAAT, whereas age and comorbidities showed a negative association. CONCLUSION: Our results show that the management of osteoporosis in postmenopausal hip fracture patients has significantly improved over the last decade. From our point of view, the main impact on this development is due to the implementation of a GFC with corresponding guidelines and treatment steps. In addition to structural changes, the improved evidence for osteoporosis treatment, especially of geriatric patients, has a positive influence on osteoporosis therapy.