Skip to main content
Erschienen in: Archives of Osteoporosis 1/2020

01.12.2020 | Original Article

Elderly men have much lower vertebral fracture risk than elderly women even at advanced age: the MrOS and MsOS (Hong Kong) year 14 follow-up radiology results

verfasst von: Yì Xiáng J. Wáng, Nazmi Che-Nordin, Jason C. S. Leung, Blanche Wai Man Yu, James F. Griffith, Timothy C. Y. Kwok

Erschienen in: Archives of Osteoporosis | Ausgabe 1/2020

Einloggen, um Zugang zu erhalten

Abstract

Summary

MrOS MsOS (Hong Kong) studies year 14 follow-up shows for subjects without baseline osteoporotic vertebral deformity, women’s incident vertebral fracture (VF) rate was twice that of men. For subjects with vertebral deformity of baseline ≥ 20% height loss, counting subject, women’s incident VF rate was three times higher than that of men.

Introduction

For MrOS MsOS (Hong Kong) baseline (BL) studies, 2000 men and 2000 women ≥ 65 years were recruited during 2001 to 2003. This study presents the year 14 follow-up (FU).

Materials

Whole spine MRI was performed in 271 males (mean, 82.8 ± 3.6 years) and 150 females (mean, 82.0 ± 4.29 years). Osteoporotic vertebral deformity (OVD) classification included no OVD (grade 0), and OVDs with < 20%, 20~25%, > 25%~1/3, > 1/3~40%, > 40%~2/3, and > 2/3 height loss (grade 1~6). With an existing VD, a further height loss of ≥ 15% was a VD progression. A new incident VD was a change from grade 0 to ≥ grade 2 or to grade 1 with ≥ 10% height loss. OVD progression and new incident OVD were considered incident VF.

Results

The proportion of osteoporotic subjects only slightly increased during FU for men but doubled for women. Groupwise, OVD was not associated with back pain in men; but OVD with > 1/3 height loss was associated with back pain in women. For subjects without BL OVD, 7.9% of men and 14.6% of women had incident VF. For subjects with BL OVD of ≥ 20% height loss, men’s and women’s incident VF were 17.6% and 52.6%, respectively, counting subject and 1.68% and 7.89%, respectively, counting vertebra.

Conclusion

Elderly men with or without existing osteoporotic VD have much lower future VF risk than elderly women.
Literatur
1.
Zurück zum Zitat Szulc P, Bouxsein ML (2011) Overview of osteoporosis: epidemiology and clinical management. Vertebral Fracture Initiative Resource Document. Nyon, Switzerland: International Osteoporosis Foundation; PART I. p. 1–65 Szulc P, Bouxsein ML (2011) Overview of osteoporosis: epidemiology and clinical management. Vertebral Fracture Initiative Resource Document. Nyon, Switzerland: International Osteoporosis Foundation; PART I. p. 1–65
2.
Zurück zum Zitat Ismail AA, O'Neill TW, Cooper C, Finn JD, Bhalla AK, Cannata JB, Delmas P, Falch JA, Felsch B, Hoszowski K, Johnell O, Diaz-Lopez JB, Lopez Vaz A, Marchand F, Raspe H, Reid DM, Todd C, Weber K, Woolf A, Reeve J, Silman AJ (1998) Mortality associated with vertebral deformity in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 8:291–297CrossRef Ismail AA, O'Neill TW, Cooper C, Finn JD, Bhalla AK, Cannata JB, Delmas P, Falch JA, Felsch B, Hoszowski K, Johnell O, Diaz-Lopez JB, Lopez Vaz A, Marchand F, Raspe H, Reid DM, Todd C, Weber K, Woolf A, Reeve J, Silman AJ (1998) Mortality associated with vertebral deformity in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 8:291–297CrossRef
3.
Zurück zum Zitat Broy SB (2016) The vertebral fracture cascade: etiology and clinical implications. J Clin Densitom 19:29–34CrossRef Broy SB (2016) The vertebral fracture cascade: etiology and clinical implications. J Clin Densitom 19:29–34CrossRef
4.
Zurück zum Zitat Schwartz EN, Steinberg (2005) Detection of vertebral fractures. Curr Osteoporos Rep 3:126–135CrossRef Schwartz EN, Steinberg (2005) Detection of vertebral fractures. Curr Osteoporos Rep 3:126–135CrossRef
5.
Zurück zum Zitat Wang YX (2018) Senile osteoporosis is associated with disc degeneration. Quant Imaging Med Surg 8:551–556CrossRef Wang YX (2018) Senile osteoporosis is associated with disc degeneration. Quant Imaging Med Surg 8:551–556CrossRef
6.
Zurück zum Zitat Lyles KW, Gold DT, Shipp KM, Pieper CF, Martinez S, Mulhausen PL (1993) Association of osteoporotic vertebral compression fractures with impaired functional status. Am J Med 94:595–601CrossRef Lyles KW, Gold DT, Shipp KM, Pieper CF, Martinez S, Mulhausen PL (1993) Association of osteoporotic vertebral compression fractures with impaired functional status. Am J Med 94:595–601CrossRef
7.
Zurück zum Zitat Schlaich C, Minne HW, Bruckner T, Wagner G, Gebest HJ, Grunze M, Ziegler R, Leidig-Bruckner G (1998) Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 8:261–267CrossRef Schlaich C, Minne HW, Bruckner T, Wagner G, Gebest HJ, Grunze M, Ziegler R, Leidig-Bruckner G (1998) Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 8:261–267CrossRef
8.
Zurück zum Zitat Kwok AW, Gong JS, Wang YX, Leung JC, Kwok T, Griffith JF, Leung PC (2013) Prevalence and risk factors of radiographic vertebral fractures in elderly Chinese men and women: results of Mr. OS (Hong Kong) and Ms. OS (Hong Kong) studies. Osteoporos Int 24:877–885CrossRef Kwok AW, Gong JS, Wang YX, Leung JC, Kwok T, Griffith JF, Leung PC (2013) Prevalence and risk factors of radiographic vertebral fractures in elderly Chinese men and women: results of Mr. OS (Hong Kong) and Ms. OS (Hong Kong) studies. Osteoporos Int 24:877–885CrossRef
9.
Zurück zum Zitat Deng M, Zeng XJ, He LC, Leung JCS, Kwok AWL, Griffith JF, Kwok T, Leung PC, Wáng YX (2019) Osteoporotic vertebral fracture prevalence in elderly Chinese men and women: a comparison of endplate/cortex fracture-based and morphometrical deformity-based methods. J Clin Densitom 22:409–419CrossRef Deng M, Zeng XJ, He LC, Leung JCS, Kwok AWL, Griffith JF, Kwok T, Leung PC, Wáng YX (2019) Osteoporotic vertebral fracture prevalence in elderly Chinese men and women: a comparison of endplate/cortex fracture-based and morphometrical deformity-based methods. J Clin Densitom 22:409–419CrossRef
10.
Zurück zum Zitat Wang YX, Che-Nordin N, Deng M, Leung JCS, Kwok AWL, He LC, Griffith JF, Kwok TCY, Leung PC (2019) Osteoporotic vertebral deformity with endplate/cortex fracture is associated with higher further vertebral fracture risk: the Ms. OS (Hong Kong) study results. Osteoporos Int 30:897–905CrossRef Wang YX, Che-Nordin N, Deng M, Leung JCS, Kwok AWL, He LC, Griffith JF, Kwok TCY, Leung PC (2019) Osteoporotic vertebral deformity with endplate/cortex fracture is associated with higher further vertebral fracture risk: the Ms. OS (Hong Kong) study results. Osteoporos Int 30:897–905CrossRef
11.
Zurück zum Zitat Wang YX, Che-Nordin N, Deng M, Griffith JF, Leung JCS, Kwok AWL, Leung PC, Kwok TCY (2019) Elderly males with or without existing osteoporotic vertebral fracture have much lower future vertebral fracture risk than elderly females: the MrOS (Hong Kong) year-4 follow-up spine radiograph study. Osteoporos Int 30:2505–2514CrossRef Wang YX, Che-Nordin N, Deng M, Griffith JF, Leung JCS, Kwok AWL, Leung PC, Kwok TCY (2019) Elderly males with or without existing osteoporotic vertebral fracture have much lower future vertebral fracture risk than elderly females: the MrOS (Hong Kong) year-4 follow-up spine radiograph study. Osteoporos Int 30:2505–2514CrossRef
12.
Zurück zum Zitat Wang YX, Che-Nordin N, Leung JCS, Kwok TCY (2020) Existing severe osteoporotic vertebral fractures in elderly Chinese males were only weakly associated with higher further vertebral fracture risk at year-4 follow-up. Osteoporos Int 31:1593–1594CrossRef Wang YX, Che-Nordin N, Leung JCS, Kwok TCY (2020) Existing severe osteoporotic vertebral fractures in elderly Chinese males were only weakly associated with higher further vertebral fracture risk at year-4 follow-up. Osteoporos Int 31:1593–1594CrossRef
13.
Zurück zum Zitat Wang XR, Kwok TCY, Griffith JF, Man Yu BW, Leung JCS (2019) Wang YX (2019) Prevalence of cervical spine degenerative changes in elderly population and its weak association with aging, neck pain, and osteoporosis. Ann Transl Med 7:486CrossRef Wang XR, Kwok TCY, Griffith JF, Man Yu BW, Leung JCS (2019) Wang YX (2019) Prevalence of cervical spine degenerative changes in elderly population and its weak association with aging, neck pain, and osteoporosis. Ann Transl Med 7:486CrossRef
14.
Zurück zum Zitat Wang YX, Diacinti D, Yu W, Cheng XG, Nogueira-Barbosa MH, Che-Nordin N, Guglielmi G, Ruiz Santiago F (2020) Semi-quantitative grading and extended semi-quantitative grading for osteoporotic vertebral deformity: a radiographic image database for education and calibration. Ann Transl Med 8:398CrossRef Wang YX, Diacinti D, Yu W, Cheng XG, Nogueira-Barbosa MH, Che-Nordin N, Guglielmi G, Ruiz Santiago F (2020) Semi-quantitative grading and extended semi-quantitative grading for osteoporotic vertebral deformity: a radiographic image database for education and calibration. Ann Transl Med 8:398CrossRef
15.
Zurück zum Zitat Deng M, Kwok TCY, Leung JCS, Leung PC, Wang YX (2018) All osteoporotically deformed vertebrae with >34% height loss have radiographically identifiable endplate/cortex fracture. J Orthop Translat 14:63–66CrossRef Deng M, Kwok TCY, Leung JCS, Leung PC, Wang YX (2018) All osteoporotically deformed vertebrae with >34% height loss have radiographically identifiable endplate/cortex fracture. J Orthop Translat 14:63–66CrossRef
16.
Zurück zum Zitat Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148CrossRef Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148CrossRef
17.
Zurück zum Zitat Wang YX (2016) Menopause as a potential cause for higher prevalence of low back pain in women than in age-matched men. J Orthop Translat 8:1–4CrossRef Wang YX (2016) Menopause as a potential cause for higher prevalence of low back pain in women than in age-matched men. J Orthop Translat 8:1–4CrossRef
18.
Zurück zum Zitat Cunningham LS, Kelsey JL (1984) Epidemiology of musculoskeletal impairments and associated disability. Am J Public Health 74:574–579CrossRef Cunningham LS, Kelsey JL (1984) Epidemiology of musculoskeletal impairments and associated disability. Am J Public Health 74:574–579CrossRef
19.
Zurück zum Zitat Brodman K, Erdmann AJ, Lorge I, Wolff HG (1953) The Cornell Medical Index-Health Questionnaire. VI. The relation of patients’ complaints to age, sex, race, and education. J Gerontol 8:339–342CrossRef Brodman K, Erdmann AJ, Lorge I, Wolff HG (1953) The Cornell Medical Index-Health Questionnaire. VI. The relation of patients’ complaints to age, sex, race, and education. J Gerontol 8:339–342CrossRef
20.
Zurück zum Zitat Unruh AM (1996) Gender variation in clinical pain experience. Pain 65:123–167CrossRef Unruh AM (1996) Gender variation in clinical pain experience. Pain 65:123–167CrossRef
21.
Zurück zum Zitat Kherad M, Rosengren BE, Hasserius R, Nilsson JÅ, Redlund-Johnell I, Ohlsson C, Lorentzon M, Mellström D, Karlsson MK (2015) Low clinical relevance of a prevalent vertebral fracture in elderly men--the MrOs Sweden study. Spine J 15:281–289CrossRef Kherad M, Rosengren BE, Hasserius R, Nilsson JÅ, Redlund-Johnell I, Ohlsson C, Lorentzon M, Mellström D, Karlsson MK (2015) Low clinical relevance of a prevalent vertebral fracture in elderly men--the MrOs Sweden study. Spine J 15:281–289CrossRef
22.
Zurück zum Zitat Waterloo S, Søgaard AJ, Ahmed LA, Damsgård E, Morseth B, Emaus N (2013) Vertebral fractures and self-perceived health in elderly women and men in a population-based cross-sectional study: the Tromsø Study 2007-08. BMC Geriatr 13:102CrossRef Waterloo S, Søgaard AJ, Ahmed LA, Damsgård E, Morseth B, Emaus N (2013) Vertebral fractures and self-perceived health in elderly women and men in a population-based cross-sectional study: the Tromsø Study 2007-08. BMC Geriatr 13:102CrossRef
23.
Zurück zum Zitat Che-Nordin N, Deng M, Griffith JF, Leung JCS, Kwok AWL, Zhu YQ, So RHY, Kwok TCY, Leung PC, Wáng YX (2018) Prevalent osteoporotic vertebral fractures more likely involve the upper endplate than the lower endplate and even more so in males. Ann Transl Med 6:442CrossRef Che-Nordin N, Deng M, Griffith JF, Leung JCS, Kwok AWL, Zhu YQ, So RHY, Kwok TCY, Leung PC, Wáng YX (2018) Prevalent osteoporotic vertebral fractures more likely involve the upper endplate than the lower endplate and even more so in males. Ann Transl Med 6:442CrossRef
24.
Zurück zum Zitat Muratore M, Ferrera A, Masse A, Bistolfi A (2018) Osteoporotic vertebral fractures: predictive factors for conservative treatment failure. A systematic review. Eur Spine J 27:2565–2576CrossRef Muratore M, Ferrera A, Masse A, Bistolfi A (2018) Osteoporotic vertebral fractures: predictive factors for conservative treatment failure. A systematic review. Eur Spine J 27:2565–2576CrossRef
25.
Zurück zum Zitat Kim DH, Vaccaro AR (2006) Osteoporotic compression fractures of the spine; current options and considerations for treatment. Spine J 6:479–487CrossRef Kim DH, Vaccaro AR (2006) Osteoporotic compression fractures of the spine; current options and considerations for treatment. Spine J 6:479–487CrossRef
26.
Zurück zum Zitat Zeng Q, Li N, Wang Q, Feng J, Sun D, Zhang Q, Huang J, Wen Q, Hu R, Wang L, Ma Y, Fu X, Dong S, Cheng X (2019) The prevalence of osteoporosis in China, a nationwide, multicenter DXA survey. J Bone Miner Res 34:1789–1797CrossRef Zeng Q, Li N, Wang Q, Feng J, Sun D, Zhang Q, Huang J, Wen Q, Hu R, Wang L, Ma Y, Fu X, Dong S, Cheng X (2019) The prevalence of osteoporosis in China, a nationwide, multicenter DXA survey. J Bone Miner Res 34:1789–1797CrossRef
27.
Zurück zum Zitat Sheu Y, Cauley JA, Wheeler VW, Patrick AL, Bunker CH, Ensrud KE, Orwoll ES, Zmuda JM, Osteoporotic Fracture in Men (MrOS) Research Group (2011) Age-related decline in bone density among ethnically diverse older men. Osteoporos Int 22:599–605CrossRef Sheu Y, Cauley JA, Wheeler VW, Patrick AL, Bunker CH, Ensrud KE, Orwoll ES, Zmuda JM, Osteoporotic Fracture in Men (MrOS) Research Group (2011) Age-related decline in bone density among ethnically diverse older men. Osteoporos Int 22:599–605CrossRef
28.
Zurück zum Zitat Fujiwara S, Kasagi F, Masunari N, Naito K, Suzuki G (2003) Fukunaga M (2003) Fracture prediction from bone mineral density in Japanese men and women. J Bone Miner Res 18:1547–1553CrossRef Fujiwara S, Kasagi F, Masunari N, Naito K, Suzuki G (2003) Fukunaga M (2003) Fracture prediction from bone mineral density in Japanese men and women. J Bone Miner Res 18:1547–1553CrossRef
29.
Zurück zum Zitat Sugita M, Watanabe N, Mikami Y, Hase H, Kubo T (2005) Classification of vertebral compression fractures in the osteoporotic spine. J Spinal Disord Tech 18:376–381CrossRef Sugita M, Watanabe N, Mikami Y, Hase H, Kubo T (2005) Classification of vertebral compression fractures in the osteoporotic spine. J Spinal Disord Tech 18:376–381CrossRef
30.
Zurück zum Zitat Lentle BC, Berger C, Probyn L, Brown JP, Langsetmo L, Fine B, Lian K, Shergill AK, Trollip J, Jackson S, Leslie WD, Prior JC, Kaiser SM, Hanley DA, Adachi JD, Towheed T, Davison KS, Cheung AM, Goltzman D, CaMos Research Group (2018) Comparative analysis of the radiology of osteoporotic vertebral fractures in women and men: cross-sectional and longitudinal observations from the Canadian Multicentre Osteoporosis Study (CaMos). J Bone Miner 33:569–579CrossRef Lentle BC, Berger C, Probyn L, Brown JP, Langsetmo L, Fine B, Lian K, Shergill AK, Trollip J, Jackson S, Leslie WD, Prior JC, Kaiser SM, Hanley DA, Adachi JD, Towheed T, Davison KS, Cheung AM, Goltzman D, CaMos Research Group (2018) Comparative analysis of the radiology of osteoporotic vertebral fractures in women and men: cross-sectional and longitudinal observations from the Canadian Multicentre Osteoporosis Study (CaMos). J Bone Miner 33:569–579CrossRef
32.
Zurück zum Zitat Karlsson MK, Kherad M, Hasserius R, Nilsson JÅ, Redlund-Johnell I, Ohlsson C, Lorentzon M, Mellström D, Rosengren BE (2016) Characteristics of prevalent vertebral fractures predict new fractures in elderly men. J Bone Joint Surg Am 98:379–385CrossRef Karlsson MK, Kherad M, Hasserius R, Nilsson JÅ, Redlund-Johnell I, Ohlsson C, Lorentzon M, Mellström D, Rosengren BE (2016) Characteristics of prevalent vertebral fractures predict new fractures in elderly men. J Bone Joint Surg Am 98:379–385CrossRef
34.
Zurück zum Zitat Wáng YX, Lentle BC (2020) Radiographic osteoporotic vertebral fractures in elderly men: a brief review focusing on differences between sexes. Quant Imaging Med Surg 10:1863–1876CrossRef Wáng YX, Lentle BC (2020) Radiographic osteoporotic vertebral fractures in elderly men: a brief review focusing on differences between sexes. Quant Imaging Med Surg 10:1863–1876CrossRef
35.
Zurück zum Zitat Chang HT, Chen CK, Chen CW, Lin MH, Peng LN, Chang CY, Chen LK (2012) Unrecognized vertebral body fractures (VBFs) in chest radiographic reports in Taiwan: a hospital-based study. Arch Gerontol Geriatr 55:301–304CrossRef Chang HT, Chen CK, Chen CW, Lin MH, Peng LN, Chang CY, Chen LK (2012) Unrecognized vertebral body fractures (VBFs) in chest radiographic reports in Taiwan: a hospital-based study. Arch Gerontol Geriatr 55:301–304CrossRef
36.
Zurück zum Zitat Lauridsen KN, De Carvalho A, Andersen AH (1984) Degree of vertebral wedging of the dorso lumbar spine. Acta Radiol Diagn (Stockh) 25:29–32CrossRef Lauridsen KN, De Carvalho A, Andersen AH (1984) Degree of vertebral wedging of the dorso lumbar spine. Acta Radiol Diagn (Stockh) 25:29–32CrossRef
37.
Zurück zum Zitat Matsumoto M, Okada E, Kaneko Y, Ichihara D, Watanabe K, Chiba K, Toyama Y, Fujiwara H, Momoshima S, Nishiwaki Y, Hashimoto T, Takahata T (2011) Wedging of vertebral bodies at the thoracolumbar junction in asymptomatic healthy subjects on magnetic resonance imaging. Surg Radiol Anat 33:223–228CrossRef Matsumoto M, Okada E, Kaneko Y, Ichihara D, Watanabe K, Chiba K, Toyama Y, Fujiwara H, Momoshima S, Nishiwaki Y, Hashimoto T, Takahata T (2011) Wedging of vertebral bodies at the thoracolumbar junction in asymptomatic healthy subjects on magnetic resonance imaging. Surg Radiol Anat 33:223–228CrossRef
38.
Zurück zum Zitat Abdel-Hamid Osman A, Bassiouni H, Koutri R, Nijs J, Geusens P, Dequeker J (1994) Aging of the thoracic spine: distinction between wedging in osteoarthritis and fracture in osteoporosis-a cross-sectional and longitudinal study. Bone 15:437–442CrossRef Abdel-Hamid Osman A, Bassiouni H, Koutri R, Nijs J, Geusens P, Dequeker J (1994) Aging of the thoracic spine: distinction between wedging in osteoarthritis and fracture in osteoporosis-a cross-sectional and longitudinal study. Bone 15:437–442CrossRef
39.
Zurück zum Zitat Leidig-Bruckner G, Limberg B, Felsenberg D, Bruckner T, Holder S, Kather A, Miksch J, Wüster C, Ziegler R, Scheidt-Nave C (2000) Sex difference in the validity of vertebral deformities as an index of prevalent vertebral osteoporotic fractures: a population survey of older men and women. Osteoporos Int 11:102–119CrossRef Leidig-Bruckner G, Limberg B, Felsenberg D, Bruckner T, Holder S, Kather A, Miksch J, Wüster C, Ziegler R, Scheidt-Nave C (2000) Sex difference in the validity of vertebral deformities as an index of prevalent vertebral osteoporotic fractures: a population survey of older men and women. Osteoporos Int 11:102–119CrossRef
40.
Zurück zum Zitat Wang YX, Wang XR, Che-Nordin N, Xu FR, Huang QL (2019) On the possibility of over-diagnosis of osteoporotic vertebral fracture at mid-thoracic level. J Thorac Dis 11:5708–5711CrossRef Wang YX, Wang XR, Che-Nordin N, Xu FR, Huang QL (2019) On the possibility of over-diagnosis of osteoporotic vertebral fracture at mid-thoracic level. J Thorac Dis 11:5708–5711CrossRef
42.
Zurück zum Zitat Szulc P, Munoz F, Marchand F, Delmas PD (2001) Semiquantitative evaluation of prevalent vertebral deformities in men and their relationship with osteoporosis: the MINOS study. Osteoporos Int 12:302–310CrossRef Szulc P, Munoz F, Marchand F, Delmas PD (2001) Semiquantitative evaluation of prevalent vertebral deformities in men and their relationship with osteoporosis: the MINOS study. Osteoporos Int 12:302–310CrossRef
Metadaten
Titel
Elderly men have much lower vertebral fracture risk than elderly women even at advanced age: the MrOS and MsOS (Hong Kong) year 14 follow-up radiology results
verfasst von
Yì Xiáng J. Wáng
Nazmi Che-Nordin
Jason C. S. Leung
Blanche Wai Man Yu
James F. Griffith
Timothy C. Y. Kwok
Publikationsdatum
01.12.2020
Verlag
Springer London
Erschienen in
Archives of Osteoporosis / Ausgabe 1/2020
Print ISSN: 1862-3522
Elektronische ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-020-00845-x

Weitere Artikel der Ausgabe 1/2020

Archives of Osteoporosis 1/2020 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.