Therapiehinweise im Lichte täglicher Praxis am Beispielder Osteoporose

Aim: The German Federal Joint Committee (G-BA) issued a therapeutic advice for teriparatide in 2007. However, exceptions may occur in patients, if other major reasons can be found by treating physicians. Aim of this study is to identify patient cases, which were treated under this exception rule and potentially form clusters of underlying additional factors. Method: Retrospectively the records of patients with severe osteoporosis of a specialised outpatient orthopaedist from 2004 to 2006 were viewed. Out of this group those cases were identified, which were treated with teriparatide outside the strict classification of the current GBA guidelines. In a second step, these cases were grouped into clusters. Results: In total, 90 patients were identified which match the inclusion criteria. Four clusters of patients with joint characteristics were formed, which werent fully or partially covered by the G-BA guidelines, including i. e. patients with rheumatic diseases. Conclusion: Recommendations and guidelines are necessary to manage the medical care effectively and efficiently. Nevertheless, the identified individual patient careers show that not only standard cases exist in medical daily routine to which recommendations and guidelines apply easily. Reflecting the gap between external and internal validity there always exist cases not fitting into fixed recommendations.