Discrepancies Between Osteoporotic Fracture Evaluations in Men Based on German (DVO) Osteoporosis Guidelines or the FRAX Score.

INTRODUCTION: Established scores estimate 10-year fracture risk in osteoporosis to assist with treatment recommendations. This study compared the risk probabilities of major osteoporotic and hip fractures calculated by the FRAX tool with those of the DVO score, established in German-speaking countries. MATERIAL AND METHODS: This seven-year retrospective study analyzed data of 125 male patients (mean age: 59.2±10.7 years) evaluated for osteoporosis. For the DVO score, the therapy threshold of>30% for vertebral and hip fractures suggested by DVO guidelines was implemented. We calculated fracture risks based on FRAX scores with aBMD and applied a common therapy threshold of≥3% for hip fracture and subsequently determined the "DVO-equivalent risk level" for FRAX-based assessment that would identify as many male patients as identified by the DVO score. RESULTS: Based on DVO score, 60.0% of patients had a 10-year risk of hip and vertebral fractures>30%. The recommendations for individuals based on FRAX scores for hip fracture with aBMD with risk≥3% overlapped with those based on DVO score in 36% of patients. Patients identified for treatment only by DVO score presented a higher percentage of spine fractures (65 vs. 41%). The thresholds for this "DVO-equivalent risk level" for 'FRAX with aBMD' was estimated to be≥6.7% for major osteoporotic fracture and≥2.1% for hip fracture.This study demonstrates that the DVO score was more sensitive than the FRAX score for patients with prevalent spinal fractures. We suggest considering the appropriate score and therapy threshold carefully in the daily care of male patients.

[Neurolytic block of the lumbar sympathetic trunk in advanced stages of peripheral arterial occlusive disease]. / Neurolytische Blockaden des lumbalen Grenzstrangs in fortgeschrittenen Stadien der peripheren arteriellen Verschlusskrankheit.

UNLABELLED: Neurolytic blocks of the lumbar sympathetic trunk enable a less invasive sympathetic denervation if compared to standard surgical procedures. METHODS: 34 patients undergoing chemical lumbar sympathectomy (CLS) for advanced arterial occlusive disease were prospectively studied. An actual indication for reconstructive vascular surgical intervention had been excluded in all patients. The sympatholytic efficacy, different haemodynamic variables, the relief of rest pain and the effect on ischaemic ulcers were quantified before, 3 and 21 days after CLS. RESULTS: The mean intensity of rest pain, as assessed on a visual analogue scale (0-100 mm), significantly decreased from 60 mm to 31 and 34 mm, respectively. 9 of 12 patients with ischaemic ulcers showed partial or complete remission within the study period. Overall, in 88% of patients sympathetic denervation could be demonstrated by ablation of the sympatho-galvanic skin response. The mean difference in skin temperature between the treated and the untreated leg significantly increased from -0.73 degrees C to +0.34 and +0.39 degrees C, respectively. Doppler-sonographic measurements of the ankle-pressure-index showed a minor increase from 0.34 to 0.36 and 0.42; however, these changes did not reach significance. Neither changes of the different physiologic variables nor data of the patient history could predict the relief of rest pain after CLS. The only side effect of CLS was transient neuralgia of the genitofemoral nerve occurring in 19% of patients. CONCLUSION: Considering the relatively short follow-up period, the results of this study support evidence of the therapeutic efficacy of CLS for rest pain and ischaemic ulcers in patients with advanced arterial disease. The prognostic value of standard variables for estimation of sympathetic reactivity and skin blood flow, however, could not be confirmed.