Osteoporotic fractures are major cause of disability and death. If we want to effectively prevent them, we should treat individuals at high risk of fracture. Primarily, we treat patients after osteoporotic vertebral or hip fracture, where it is required only to exclude secondary causes of osteoporosis prior to initiating treatment. For other women after menopause, the risk of fracture could be assessed using clinical factors, which are entered into the computer-driven FRAX algorithm. The measurement of bone mineral density could also be used, but we have to take into account the age and sex of subjects when interpreting the result. Treatment of osteoporosis requires a healthy lifestyle without smoking and excessive alcohol intake. The diet should be rich in calcium and protein. Regular physical exercise has positive effects on the bone as well as on the muscles and fall prevention. The addition of vitamin D is always recommended. Drugs have proven efficacy against osteoporotic fractures. We can choose between several inhibitors of bone resorption, such as estrogens, biophosphonates, raloxifene and denosumab. Teriparatide is an anabolic drug that promotes bone formation, while strontium ranelate has a beneficial effect on both processes of bone turnover.
F.22 Improvement to existing health/diagnostic methods/procedures
COBISS.SI-ID: 4635711Recent survey amongst trauma surgeons in Slovenia showed that after an osteoporotic hip fracture only a small minority of the respondents would prescribe (6 %) or recommend (17 %) any kind of treatment for osteoporosis to their patients. To improve efficiency of care after hip fractures the national recommendations were written and adopted by the Board for Surgery at the Ministry of Health in 2011. Recommendations: Hip fracture after a fall from a standing height is equivalent to osteoporosis and DXA is not needed for the diagnosis. Every trauma department in the country should have a registered nurse (RN) who acts as a dedicated coordinator, screens and educates patients or their relatives. She is responsible that basic laboratory studies are done for the assessment of osteoporosis. All eligible patients after a hip fracture should start with vitamin D3 2000 IU daily and 500 mg of calcium supplement daily before the discharge. The discharge letter should include the diagnosis of osteoporosis with fracture, instructions for additional laboratory tests to be done if needed and a clear recommendation that medical treatment should be introduced. After the discharge RN from the trauma department should get in contact with general physician, physiatrist or any other medical doctor who takes care of the patient via phone and check if everything was done according to the instructions in the discharge letter. Oral bisphosphonates are regarded as the first line treatment, while denosumab is reserved for patients over 70 years old and zoledronic acid is given to patients who cannot tolerate any other drug. If hip fracture was sustained when on appropriate treatment patient could be put on teriparatide. Unfortunately, these recommendations are still not widely implemented, due to lack of funding. However, level of knowledge about osteoporosis among trauma surgeons and their patients after hip (and other) fractures substantially increased in the last two years.
F.22 Improvement to existing health/diagnostic methods/procedures
COBISS.SI-ID: 607395Introduction: Evidence based recommendations are needed to guide the acute management of the bleeding trauma patient when these recommendations are implemented patient outcomes may be improved. Methods: The Multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document represents an updated version of the guideline published by the group in 2007 and updated in 2010. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature. Results: Key changes ecompassed in this version of the guideline include new recommendations on the appropriate use of vasopressors and inotropic agents, and reflect an awareness of the growing number of patients in the population at large treated with antiplateled agents and/or oral anticoagulants. The current guideline also includes recommendations and a discussion of thromboprophylactic strategies for all patients following traumetic injury. The most significant addiction is a new section that discusses the need for every institution to develop, implement and adhere to an evidence-based clinical protocol to manage traumatically injured patients. The remaining recommendations have been re-evaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies. Conclusions: A comprehensive, multidisciplinary approach to trauma care and mechanisms with which to ensure that established protocols are consistently implemented will ensure a uniform and high standard of care across Europe and beyond.
F.22 Improvement to existing health/diagnostic methods/procedures
COBISS.SI-ID: 607139