No | Overarching principles | Level of Agreement (Mean (SD)) | ||
1 | The management of patients at risk of a fragility fracture should be based on shared decision making between patients and non-physician HPs. | 9 (1.8) | ||
2 | Non-physician HPs should be involved in the management of patients at risk of fragility fractures. | 8.4 (2.2) | ||
No | Point to consider | Level of evidence | Strength of recommendation | Level of Agreement (Mean (SD)) |
Prevention of Fragility Fractures | Median (Range) | |||
1 | Identification of patients at risk of fracture | |||
Non-physician HPs should identify patients at risk of fragility fracture, ensure that the patients are offered opportunities for adequate treatment and address bone fragility in patient education. | 9.06 (1.16) | |||
2 | B | |||
9.5 (7–10) | ||||
2 | Fall risk evaluation | |||
Non-physician HPs should start with fall risk evaluation of patients at risk of fragility fracture. Patients at high-risk of falls should be assessed by non-physician HPs using an individualised approach to multi-component screening or referred to one or more non-physician HPs competent in multi-component screening. | 4 | C | 9.61 (0.70) | |
10 (8 to 10) | ||||
3 | Preventive multicomponent interventions | |||
Tailored multicomponent interventions, including for example: | ||||
| 1 to 3 | A | 9.33 (0.91) | |
| 2 | D | ||
| 1 to 2 | D | 10 (8 to 10) | |
| 2 | D | ||
should be offered to patients at high-risk of primary osteoporotic fracture and/or high-risk of falls | ||||
4 | Avoidance of smoking and overuse of alcohol | |||
Smoking and overuse of alcohol should be discouraged. | 1 | A | 9.22 (1.31) | |
10 (5 to 10) | ||||
No | Point to consider | Level of evidence | Strength of recommendation | Level of Agreement (Mean (SD)) |
Management of Fragility Fractures | Median (Range) | |||
5 | Exercise and nutritional interventions for patients who have experienced a fragility fracture | |||
Non-physician HPs should ensure that patients who have experienced a fragility fracture are given opportunities for: | ||||
| 1 to 2 | A | 9.22 (0.88) | |
| 2 | D | ||
Calcium and vitamin D intake should be discussed with the patient focussing on actual and recommended daily calcium intake, calcium and vitamin D rich foods, and the individual’s risk/benefit profile for vitamin D supplementation. | 1 to 2 | D | 9.5 (8 to 10) | |
6 | Organisation and coordination of multidisciplinary services | |||
Non-physician HPs should be included in orthogeriatric services, FLS and/or a coordinated, multidisciplinary post-fracture prevention programme. Patients with fragility fractures should be referred to a FLS or an adequate, coordinated, multidisciplinary post-fracture prevention programme | 1 to 2 | 9.50 (1.10) | ||
10 (6 to 10) | ||||
7 | Adherence to anti-osteoporosis medicines | |||
Non-physician HPs should address, monitor and support medication adherence in a structured follow-up. | 2 to 3 | B | 8.83 (1.25) | |
9 (6 to 10) |
EULAR, European League Against Rheumatism; FLS, fracture liaison services; HPs, health professionals.