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EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures
  1. W F Lems1,
  2. K E Dreinhöfer2,
  3. H Bischoff-Ferrari3,
  4. M Blauth4,
  5. E Czerwinski5,
  6. JAP da Silva6,
  7. A Herrera7,
  8. P Hoffmeyer8,
  9. T Kvien9,
  10. G Maalouf10,
  11. D Marsh11,
  12. J Puget*,12,
  13. W Puhl13,
  14. G Poor14,
  15. L Rasch1,
  16. C Roux15,
  17. S Schüler2,
  18. B Seriolo16,
  19. U Tarantino17,
  20. T van Geel18,
  21. A Woolf19,
  22. C Wyers20,21,
  23. P Geusens22,23
  1. 1Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
  2. 2Department of Orthopedics and Traumatology, Center for Musculoskeletal Surgery (CMSC), Charité Universitätsmedizin Berlin Medical Park Berlin Humboldtmühle, Berlin, Germany
  3. 3Departemnt of Geriatrics and Aging Research, University Hospital and University of Zurich, Zurich, Switzerland
  4. 4Department for Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
  5. 5Department of Bone and Joint Diseases, Jagiellonian University, Faculty of Health and Sciences, Krakow Medical Centre, Krakow, Poland
  6. 6Department of Rheumatology, Faculdade de Medicina e Centro Hospitalar, Universidade de Coimbra, Coimbra, Portugal
  7. 7Department of Surgery, University of Zaragoza, Zaragosa, Spain
  8. 8Department of Surgery, Division of Orthopaedics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
  9. 9Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  10. 10Faculty of Medicine, St. Joseph University, Bellevue University Medical Center, Beirut, Lebanon
  11. 11University College London, London, UK
  12. 12Department of Orthopaedic Surgery, Hopital Rangueil, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
  13. 13Past President EFORT, University Ulm, Germany
  14. 14Department of Internal Medicine III, National Institute of Rheumatology and Physiotherapy, Rheumatology Chair, Semmelweis University, Budapest, Hungary
  15. 15Department of Rheumatology, INSERM 1153, Cochin Hospital, Paris Descartes University, Paris, France
  16. 16Research Laboratory and Academic, Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
  17. 17Department of Orthopedics and Traumatology, Tor Vergata University of Rome, Rome, Italy
  18. 18Department of Family Medicine, Maastricht University, CAPHRI—School for Public Health and Primary Care, Maastricht, The Netherlands
  19. 19Bone and Joint Research Group, Knowledge Spa, Royal Cornwall Hospital, Truro, UK
  20. 20Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
  21. 21Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
  22. 22Department of Internal Medicine, Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
  23. 23University Hasselt, Hasselt, Belgium
  1. Correspondence to Professor Willem Lems, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Postbox 7057, 1007 MB Amsterdam, The Netherlands wf.lems{at}


The European League Against Rheumatism (EULAR) and the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) have recognised the importance of optimal acute care for the patients aged 50 years and over with a recent fragility fracture and the prevention of subsequent fractures in high-risk patients, which can be facilitated by close collaboration between orthopaedic surgeons and rheumatologists or other metabolic bone experts. Therefore, the aim was to establish for the first time collaborative recommendations for these patients. According to the EULAR standard operating procedures for the elaboration and implementation of evidence-based recommendations, 7 rheumatologists, a geriatrician and 10 orthopaedic surgeons met twice under the leadership of 2 convenors, a senior advisor, a clinical epidemiologist and 3 research fellows. After defining the content and procedures of the task force, 10 research questions were formulated, a comprehensive and systematic literature search was performed and the results were presented to the entire committee. 10 recommendations were formulated based on evidence from the literature and after discussion and consensus building in the group. The recommendations included appropriate medical and surgical perioperative care, which requires, especially in the elderly, a multidisciplinary approach including orthogeriatric care. A coordinator should setup a process for the systematic investigations for future fracture risk in all elderly patients with a recent fracture. High-risk patients should have appropriate non-pharmacological and pharmacological treatment to decrease the risk of subsequent fracture.

  • Osteoporosis
  • Bone Mineral Density
  • Orthopedic Surgery
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  • Handling editor Hans WJ Bijlsma

  • WFL and KED are co-first authors. *Jean Puget has since passed away.

  • *Jean Puget has since passed away.

  • Contributors All authors were contributor to the design of the study including the formulation of research questions, to the analysis of and the discussion around the literature and have read and given comments on the manuscript.

  • Funding Two one-day meetings were organised, these were financially supported by unrestricted grants from the European League Against Rheumatism and the European Federation of National Associations of Orthopaedics and Traumatology.

  • Competing interests WFL reports personal fees (speakers fee/advisory boards) from Amgen, Eli Lilly, Novartis and Merck. KED reports personal fees from Agnovos, Amgen, Bayer, Bertelsmann, Heel, Janssen, Eli Lilly, Merck, Sanofi and UCB. HB-F reports to have been an invited speaker/on advisory boards by Roche Diagnostics, Nestlé, Pfizer, WILD, Sanofi and Sandoz. Investigator initiated funding from Nestlé, Pfizer, WILD and DSM Nutritional Products. EC reports remuneration from Amgen and Regeneron during the conduct of the study. TK reports personal fees from AbbVie, Biogen, BMS, Boehringer Ingelheim, Celltrion, Eli Lilly, Epirus, Janssen, Merck-Serono, MSD, Mundipharma, Novartis, Oktal, Orion Pharma, Hospira/Pfizer, Roche, Sandoz and from UCB Pharma. CR reports personal fees from Amgen, MSD, Eli Lilly and grants from Ultragenyx. PG reports grants and other from Amgen and Eli Lilly, and grants from Pfizer, MSD, UCB, Abbott, BMS, Novartis, Roche and Will Pharma.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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