Objective To establish European League Against Rheumatism (EULAR) points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older.
Methods Points to consider were developed in accordance with EULAR standard operating procedures for EULAR-endorsed recommendations, led by an international multidisciplinary task force, including patient research partners and different health professionals from 10 European countries. Level of evidence and strength of recommendation were determined for each point to consider, and the mean level of agreement among the task force members was calculated.
Results Two overarching principles and seven points to consider were formulated based on scientific evidence and the expert opinion of the task force. The two overarching principles focus on shared decisions between patients and non-physician health professionals and involvement of different non-physician health professionals in prevention and management of fragility fractures. Four points to consider relate to prevention: identification of patients at risk of fracture, fall risk evaluation, multicomponent interventions to prevent primary fracture and discouragement of smoking and overuse of alcohol. The remaining three focus on management of fragility fractures: exercise and nutritional interventions, the organisation and coordination of multidisciplinary services for post-fracture models of care and adherence to anti-osteoporosis medicines. The mean level of agreement among the task force for the overarching principles and the points to consider ranged between 8.4 and 9.6.
Conclusion These first EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older serve to guide healthcare practice and education.
- multidisciplinary team-care
- health services research
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JA and NW are joint first authors.
Handling editor Désirée van der Heijde
Twitter @Stiddyo, @JennydelaTorr16
JA and NW contributed equally.
Contributors NW, JA, EH, MB, PB, MB, A-BB, KB, CCh, CCo, RGD, GG, WL, EM, SP, CS, PS, ST, JdlT-A and TAS discussed and formulated the clinical questions and interpreted the results. NW, JA, EH and TAS collected the data, performed the analysis and wrote the manuscript. All authors read and critically reviewed the manuscript prior to submission. JA and NW contributed equally to this paper.
Funding This study was funded by the European League Against Rheumatism (EULAR). Grant reference HPR 032.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting or dissemination plans of this research. Refer to the Methods section for further details.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.
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