Recommendations for patients with fragility fractures in patients aged 50 years and older
| Level of evidence | Strength of recommendation | Level of agreement | ||
|---|---|---|---|---|
| Recommendation | Average Median Range | |||
| 1 | Fragility fractures should be managed in the context of a multidisciplinary clinical system, guaranteeing adequate preoperative assessment and preparation of patients, including adequate pain relief, appropriate fluid management and surgery within 48 hours of injury | IIA | B | 9.8 10 8–10 |
| 2 | To improve functional outcome, and to reduce length of hospital stay and mortality, orthogeriatric comanagement should be provided, especially in elderly patients with hip fracture | IA | A | 9.2 10 0–10 |
| 3 | Appropriate treatment of the fractures in these, often elderly and multimorbid, patients with frail bones requires a balanced approach with regard to operative vs non-operative treatment and careful selection of fixation devices and techniques | III | C | 9.3 10 7–10 |
| 4 | Each patient aged 50 years and over with a recent fracture should be evaluated systematically for the risk of subsequent fractures | IA | A | 9.5 10 5–10 |
| 5 | Evaluation of the risk of subsequent fractures includes a review of clinical risk factors, DXA of the spine and hip, imaging of the spine for vertebral fractures and evaluation of falls risk and the identification of secondary osteoporosis, which together predict subsequent fracture risk | III | C | 9.3 10 6–10 |
| 6 | Implementation requires a local responsible lead, that is, a person/group that coordinates secondary fracture prevention based on guidelines, liaising between surgeons, rheumatologists/endocrinologists, geriatricians in case of elderly with a hip or other major fracture, and general practitioners | IV | D | 9.1 10 6–10 |
| 7 | An appropriate rehabilitation programmes should consist of both early postfracture introduction of physical training and muscle strengthening and the long-term continuation of balance training and multidimensional fall prevention | IIA | B | 9.5 10 5–10 |
| 8 | Patients should be educated about the burden of the disease, risk factors for fractures, follow-up and duration of therapy | IV | D | 9.2 10 5–10 |
| 9 | Non-pharmacological treatment is important in the prevention of fractures in high-risk patients; it includes at least an adequate intake of calcium and vitamin D, stopping smoking and limitation of alcohol intake | IV | D | 9.3 10 6–10 |
| 10 | Pharmacological treatment should preferably use drugs that have been demonstrated to reduce the risk of vertebral, non-vertebral and hip fractures, and should be regularly monitored for tolerance and adherence | IB | A | 9.9 10 9–10 |
DXA, dual energy xray absorptiometr.