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2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older
  1. Jo Adams1,
  2. Nicky Wilson1,
  3. Emalie Hurkmans2,
  4. Margot Bakkers3,
  5. Petra Balážová4,5,
  6. Mark Baxter6,
  7. Anne-Birgitte Blavnsfeldt7,
  8. Karine Briot8,
  9. Catharina Chiari9,
  10. Cyrus Cooper10,
  11. Razvan Gabriel Dragoi11,
  12. Gabriele Gäbler12,
  13. Willem Lems13,
  14. Erika Mosor12,
  15. Sandra Pais14,
  16. Cornelia Simon15,
  17. Paul Studenic16,
  18. Simon Tilley6,17,
  19. Jenny de la Torre-Aboki18,
  20. Tanja A Stamm12,19
  1. 1School of Health Sciences, University of Southampton, Southampton, UK
  2. 2Department Care I, Musculoskeletal System & Neurology, Dutch National Health Care Institute, Diemen, The Netherlands
  3. 3EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
  4. 4EULAR Young PARE, Zurich, Switzerland
  5. 5Slovak League Against Rheumatism, Piestany, Slovakia
  6. 6Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  7. 7Department of Rheumatology, Aarhus University Hospital, Arrhus, Denmark
  8. 8INSERM U1153, Paris Descartes University, Reference Center for Genetic Bone Diseases - Department of Rheumatology, Cochin Hospital, Paris, France
  9. 9Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
  10. 10MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
  11. 11Rehabilitation, Physical Medicine and Rheumatology, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Timisoara, Romania
  12. 12Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
  13. 13Department of Rheumatology, VU University Medical Centre Amsterdam, Amsterdam, Noord-Holland, The Netherlands
  14. 14Centre for Biomedical Research, Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
  15. 15Department of Balneology, Rehabilitation and Rheumatology, 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Timisoara, Romania
  16. 16Internal Medicine 3, Division of Rheumatology, Medical University Vienna, Vienna, Austria
  17. 17Trauma & Orthopaedics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  18. 18Day Hospital, Alicante General and university Hospital, Alicante, Spain
  19. 19Ludwig Boltzmann Institute Arthritis and Rehabilitation, Vienna, Austria
  1. Correspondence to Professor Tanja A Stamm, Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria; tanja.stamm{at}meduniwien.ac.at

Abstract

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.

  • osteoporosis
  • multidisciplinary team-care
  • health services research
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Footnotes

  • 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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