Osteoporosis: Bartl R

Bartl R, Anonymous00109. · Leiter des Bayerischen Osteoporosezentrums der Universität München-Grosshadern, 81366 München. · Dtsch Med Wochenschr. · Pubmed #19142840 No free full text.

This publication has no abstract.

Bartl R. · No affiliation provided · Unfallchirurg. · Pubmed #12959079 No free full text.

This publication has no abstract.

Bartl R. · Bayerisches Osteoporosezentrum der Universität München, München, Germany. · Dtsch Med Wochenschr. · Pubmed #17583832 No free full text.

Abstract: Published reports of studies on the long-term effects of anti-epileptic drugs (AED) on bone--its density, thickness, vitamin D metabolism and risk of fracture--have shown considerable methodological inadequacies (34). Despite these problems it has been clearly shown that patients with epilepsy who are on anti-epileptic drugs have a greater than normal risk of bone loss, abnormal mineralization and fractures. A patient on long-term treatment with AED has a two- to three-fold risk of sustaining a fracture. On average 50% of patients (ranging from 4-70% in different studies [18]) have an osteopathy (34). Type, dosage and duration of AED treatment determine the exact picture of the osteopathy--regardless of whether or not they are enzyme-inducing. Among the enzyme-inducing drugs, especially phenytoin, primidone, phenobarbital and carbamezapine have been investigated for their influence on vitamin D metabolism. Bone loss has also been noted even without evidence of vitamin D deficiency. Mixed forms of osteoporosis and osteomalacia occur particularly often and must be taken into account in any differentiated form of treatment. But the question remains unanswered whether current AEDs, such as lamotrigine, gabapentin or levetiracetam will cause little or no osteopathy. Comparable to the situation during long-term systemic administration of glucocorticoids, initial diagnosis, including the inexpensive dual-energy X-ray absorptiometry (DXA) and the serum concentration of 25-hydroxyvitamin D, must be obtained to determine whether initially there are any bone changes. In addition to a differentiated and clearly defined treatment of osteopathy in a patient with epilepsy, the aim must be to minimize the tendency towards seizures and their severity. The annual cost of adequate vitamin D substitution is about EUR 50, while biphosphonate treatment costs about EUR 500; the costs of vertebral or forearm fractures are about EUR 1000 and those of hip fracture about EUR 15,000. These figures exclude the costs of rehabilitation, nursing care and loss of earnings. Looked at in this way, the problem of AED-induced osteopathy has been underestimated. Yet it is actually preventable and--if already present--can be efficaciously and inexpensively treated when the new guidelines of the (German) Joint Organization of Osteology are followed. The prerequisite of rational treatment is a diagnostically clear distinction of osteoporosis and osteomalacia, but mixed forms are common. ("osteoporomalacia"). Further investigations of more recently developed AEDs (e.g. gabapentin, lamotrigine or levetiracetam) regarding their damaging action on bone during their long-term administration is essential. Systematic control of the state of bones in all patients on long-term treatment with AEDs is nowadays recommended without qualification, even though some study data are unsatisfactory or even lacking.

Bartl R. · Bayerisches Osteoporosezentrum der Universität München. · Dtsch Med Wochenschr. · Pubmed #17457784 No free full text.

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Vogel T, Bitterling H, Dobler T, Bartl R, Pfeifer KJ, Mutschler W. · Chirurgische Klinik und Poliklinik der Universität München-Innenstadt, München. · Zentralbl Chir. · Pubmed #17089289 No free full text.

Abstract: Since the World Health Organisation's announcement of the "Bone and Joint Decade 2000-2010" diseases of the musculoskeletal system attract more and more attention throughout patients and professional health care providers. In an aging society especially osteoporosis represents a major public health concern. Fragility fractures are the most limiting condition in osteoporosis with the highest impact on both, life quality and health care systems worldwide. Orthopaedic surgeons play a key role in implementing primary diagnostics and therapy in patients with fragility fractures. Objective of this effort is the reduction of the common subsequent fractures in patients with osteoporosis. According to national and international guidelines implementation of contemporary clinical pathways to diagnose and treat patients with fractures due to diminished bone mineral density is fast, simple and proven to be effective.

Bartl R, Bartl C, Mutschler W. · Bayerisches Osteoporosezentrum, Medizinische Klinik III, Klinikum der Universität München-Grosshadern. · Unfallchirurg. · Pubmed #12883779 No free full text.

Abstract: Until about 20 years ago osteoporosis was considered an inevitable disease of ageing. Now the situation has completely changed and osteoporosis is classified as a disorder which is easily diagnosed and treated in the early stages of its development that is,before a skeletal fracture has occurred. Two types of medication are available today for prophylaxis and therapy of osteoporosis: the antiresorptive and the osteoanabolic drugs whose efficacy has been demonstrated in large randomized clinical trials (RCTs). These drugs are effective not only in the early stages of osteoporosis i.e. for prevention, but also when fractures have already occurred, to reduce the risk of further skeletal fractures. However, in this setting only about 7% of patients in Germany are being treated although all are at significant risk of sustaining additional fractures. Consequently all patients with osteoporosis-related fractures should be thoroughly investigated during their hospitalisation and effective treatment instituted. In addition, treatment should be continued and monitored by the family doctor. The strategy for the administration of therapy for successful prevention of secondary fractures in osteoporosis is presented.

Bartl R. · Osteologische Ambulanz, Medizinische Klinik III, Klinikum der Universität München-Grosshadern, 81366 München. · Internist (Berl). · Pubmed #12607392 No free full text.

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Vogel T, Dobler T, Bitterling H, Biberthaler P, Kanz KG, Pfeifer KJ, Bartl R, Mutschler W. · Chirurgische Klinik und Poliklinik, Ludwig-Maximilian-Universität, München-Innenstadt. · Unfallchirurg. · Pubmed #15830174 No free full text.

Abstract: BACKGROUND: A fracture occurring in osteoporosis is a sentinel event but very rarely leads to bone mineral density (BMD) measurement or sufficient drug therapy. We designed an algorithm to evaluate BMD in older fracture patients and tested it for sustainability as well as acceptance among trauma/orthopedic surgeons. METHODS: For a 1-year period a prospective BMD test was carried out in women older than 50 and men older than 75 years of age with fractures. The commencement and conduction of therapy during the initial hospital stay and rehabilitation were also analyzed. RESULTS: From 228 members of the eligible age groups, 169 patients (74.1%) underwent BMD measurement. According to the WHO definition 71.6% showed reduced BMD in terms of osteoporosis and 24.3% in terms of osteopenia. In 84% therapy was started during initial hospital stay in 74.4% conducted during rehabilitation. CONCLUSIONS: The vast majority of older patients exhibited reduced BMD as a substantial underlying cause of their fracture. A standardized clinical plan can help to identify and treat most patients with fragility fractures.

Bartl R. · Bayerischen Osteoporosezentrums, Klinikum der Universität München. · MMW Fortschr Med. · Pubmed #19504843 No free full text.

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Bartl R, Gradinger R. · Bayerisches Osteoporosezentrum, Universität München-Grosshadern, München, Deutschland. · Orthopade. · Pubmed #19305966 No free full text.

Abstract: Osteoporosis is one of the 10 most important and widespread global diseases. In Germany alone the cost of osteoporosis runs into many billions of Euros. However, it should be noted that in the past 15 years great progress has been made both in diagnosis and in the development of new medications, and this has changed the general perception of and attitude to osteoporosis. It is now taken very seriously and recognised as a national and global disorder which is both preventable and treatable. In spite of this progress, in Europe and especially in Germany, osteoporosis remains an underdiagnosed and undertreated disease. In Germany, only about 10%-15% of patients with manifest osteoporosis are properly treated. However, in addition to national guidelines, there is now a new edition of the "European Position Paper for the Diagnosis and Management of Osteoporosis". This provides physicians treating osteoporosis patients with additional information and therefore more confidence.

Bartl R. · Bayerisches Osteoporosezentrum, Klinikum der Universität München-Grosshadern, Marchioninistrasse 15, München, Germany. · Internist (Berl). · Pubmed #18704350 No free full text.

Abstract: Osteoporosis is one of the ten most important and widespread global diseases. In Germany alone the costs of osteoporosis run into billions of Euros. However, during the past 15 years great progress has been made both in diagnosis and in the development of new medications. Osteoporosis is now taken very seriously and recognized as a national and global disorder which is now both preventable and treatable. Nevertheless, at a practical level, both in Europe and especially in Germany, osteoporosis remains an underdiagnosed and undertreated disease. In Germany, only about 10-15% of patients with manifest osteoporosis are properly treated. The consequences of such inadequate care are high additional costs-not to mention the unnecessary suffering of the patients involved. However, in support of national guidelines, a new edition of the "European Position Paper for the Diagnosis and Management of Osteoporosis" provides the doctors who treat patients with osteoporosis with additional information and therefore more confidence. In this paper several aspects are emphasized: improvements in diagnostic evaluation, assessment of the efficacy of fracture-oriented medications, and cost-effectiveness of the treatment of patients with osteoporosis.

Bartl R, Bartl C, Gradinger R. · Bayerisches Osteoporose-Zentrum, Klinikum der Universität München-Grosshadern, Marchioninistrasse 15, 81377, München, Germany. · Orthopade. · Pubmed #18528681 No free full text.

Abstract: Over the past three decades, the members of the substance group called bisphosphonates (BP) have been employed with growing success to manage osteopathies caused by increased osteoclastic activity. The following developments in BP are responsible: Modern BP are now already 20,000 times more potent than the first preparation approved for use. Their biochemical and cellular mechanisms of action have meanwhile been elucidated. They have no effect on hormones so that they are open for all patients. They are well tolerated and can be administered orally or intravenously. They have admirably been thoroughly studied in multinational trials. They are the "gold standard" in the treatment of osteoporosis, a widespread disease. Rare but serious side effects such as osteonecrosis of the jaw or acute renal insufficiency can be avoided to a large extent. BP also have tumoricidal properties and are used to suppress tumor growth in bones. Their anti-inflammatory activity is also successfully used in the treatment of bone marrow edema and bone pain.

Bartl R, Götte S, Hadji P, Hammerschmidt T. · Bayerisches Osteoporosezentrum der Universität München, Medizinische Klinik und Poliklinik III, Klinikum der Universität München, Grosshadern, München. · Dtsch Med Wochenschr. · Pubmed #16755420 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: Bisphosphonates provide efficacious treatment for osteoporosis. However, side effects often lead to patients discontinuing this treatment. This study analyses differences in adherence (including acceptance, persistence and compliance) between daily (ALD-D) and weekly (ALD-W) administration of alendronate among German patients with osteoporosis. METHODS: Prescription claims data of two random groups of subjects (144 patients each) taking ALD-D and ALD-W, respectively, were observed for 12 months after starting the given prescription. Termination was defined as the moment when the last prescription had been used up. The percentage of patients continuing the drug treatment after the first prescription was used as a measure for acceptance. Compliance was measured by the medication possession ratio (MPR), namely the percentage of days on which the patient was supplied with the medication. An MPR > 80% is therapeutically relevant because the risk of fractures is significantly reduced. RESULTS: 31.3% (ALD-W) vs. 45.8% (ALD-D) of patients discontinued therapy after one prescription. 53.5% (ALD-W) vs. 72.2% (ALD-D) of patients discontinued therapy throughout the year. The proportion of those who discontinued the treatment was significantly higher with daily administration (p=0.0035). Mean time until discontinuation was 220 days (ALD-W) vs. 169 days (ALD-D). Mean compliance among any patients was 51.7% (ALD-W) vs. 37.7% (ALD-D); Only 30.6% (ALD-W) vs. 19.2% (ALD-D) (p=0,0295) of patients reached a therapeutically relevant compliance level. CONCLUSIONS: A large proportion of patients discontinued treatment with bisphosphonates, a majority of discontinuing patients not even refilling their first prescription. Adherence, although enhanced by less frequent dosing, was suboptimal in all of its aspects, i.e. acceptance, persistence and compliance. There is a need for treatment strategies to increase adherence.

Bartl R. · LMU Munchen Klinikum, Grosshadern Medizinische Klink III. · Krankenpfl J. · Pubmed #15675394 No free full text.

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Baur A, Stäbler A, Arbogast S, Duerr HR, Bartl R, Reiser M. · Departments of Clinical Radiology, University of Munich-Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany. · Radiology. · Pubmed #12461253 links to  free full text

Abstract: PURPOSE: To evaluate the occurrence, location, and shape of the fluid sign in acute osteoporotic and neoplastic vertebral compression fractures at magnetic resonance (MR) imaging. MATERIALS AND METHODS: The study group comprised 87 consecutive patients with acute vertebral compression fractures due to osteoporotic (n = 52) or neoplastic (n = 35) infiltration. The MR imaging protocol included nonenhanced T1-weighted spin-echo and short inversion time inversion-recovery sequences and a 1.5-T system. Readers blinded to the outcome documented the occurrence, shape, and location of the fluid sign with consensus. The fluid sign was correlated with the cause, age, and severity of the fracture. The diagnosis was confirmed with surgery, follow-up MR imaging, clinical follow-up, or unequivocal imaging findings. Wilcoxon and chi(2) tests were used to assess significance. RESULTS: In fractured vertebral bodies, the fluid sign was adjacent to the fractured end plates and exhibited signal intensity isointense to that of cerebrospinal fluid. The fluid sign was linear (n = 16), triangular (n = 5), or focal (n = 2) and was significantly associated with osteoporotic fractures (21 [40%] of 52; P <.001). The fluid sign occurred in two (6%) of 35 neoplastic compression fractures. Histologic examination demonstrated osteonecrosis, edema, and fibrosis at the site of the fluid sign. There was a tendency toward older fractures exhibiting the fluid sign, but this relationship was not significant (P >.05). In osteoporotic fractures, the fluid sign was significantly associated with fracture severity (P <.05). CONCLUSION: The fluid sign is featured in acute vertebral compression fractures that show bone marrow edema. It can be an additional sign of osteoporosis and rarely occurs in metastatic fractures.

Bartl R. · No affiliation provided · Dtsch Med Wochenschr. · Pubmed #19294610 No free full text.

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Bartl R. · No affiliation provided · Dtsch Med Wochenschr. · Pubmed #19067274 No free full text.

This publication has no abstract.

Bartl R. · No affiliation provided · Dtsch Med Wochenschr. · Pubmed #19021088 No free full text.

This publication has no abstract.