A Comprehensive Fracture Prevention Strategy in Older Adults: The European Union Geriatric Medicine Society (EUGMS) Statement (original) (raw)
Related papers
Osteoporosis International, 2014
Fractures due to osteoporosis are common in older people. This study assessed the management of osteoporosis in a group of 85-year-olds and found both assessment and current treatment to be suboptimal. Introduction Fragility fractures are a major cause of excess mortality, substantial morbidity, and health and social service expenditure in older people. However, much less is known about fracture risk and its management in the very old, despite this being the fastest growing age group of our population. Methods Cross-sectional analysis of people who reached the age of 85 during the year of 2006 was carried out. Data were gathered by general practice record review (GPRR) and a multidimensional health assessment (MDHA). Results Seven hundred thirty-nine individuals were recruited. Mean age was 85.55 years (SD 0.44), and 60.2 % were female; 33.7 % (n=249) had experienced one or more fragility fractures (F 45.2 % vs M 16.3 % p<0.001); in total, 332 fractures occurred in these 249 individuals. A formal documented diagnosis of osteoporosis occurred in 12.4 %, and 38 % of individuals had experienced a fall in the last 12 months. When the fracture risk assessment tool (FRAX) and National Osteoporosis Guideline Group (NOGG) guidelines were applied, osteoporosis treatment would be recommended in 35.0 %, with a further 26.1 % identified as needing bone mineral density (BMD) measurement and 38.9 % not requiring treatment or BMD assessment. Women were more likely than men to need treatment (47.4 vs 16.3 %, p<0.001, odds ratio (OR) 4.62 (3.22-5.63)) and measurement of BMD (40.0 vs 5.1 %, p<0.001, OR 12.4 (7.13-21.6)). Of the 259 individuals identified as requiring treatment, only 74 (28.6 %) were on adequate osteoporosis treatment. Conclusion The prevalence of high fracture risk in the very old is much higher than the documented diagnosis of osteoporosis or the use of adequate treatments.
Annals of the Rheumatic Diseases, 2020
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 postfracture 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. InTROduCTIOn Countries across the world are facing a fragility fracture crisis. 1 Estimates suggest that by 2040 over 300 million adults age 50 years or more worldwide will be at high-risk of fragility fracture. 2 In 2017, across France, Germany, Italy, Spain, Sweden and the UK alone, there were 2.68 million new fragility fractures, costing an estimated €37.5 billion. 3 These numbers are projected to rise, such that in 2030 over 3.3 million new fractures are anticipated across the same six countries, with accompanying total fracturerelated costs approximating €47.4 billion. 3 Many fragility fractures require immediate acute fracture care and typically lead to physical disability, persistent pain, impaired quality of life and increased mortality. 4 Among those who sustain a fragility fracture, the risk of imminent subsequent Key messages What is already known about this subject? ► Interventions delivered by non-physician health professionals to prevent and manage fragility fractures contribute to optimal patient outcomes. They have not been sufficiently covered to date in existing European League Against Rheumatism/European Federation of National Associations of Orthopaedics and Traumatology recommendations. What does this study add? ► This paper will guide clinical practice in Europe regarding interventions delivered by nonphysician health professionals to prevent and manage fragility fractures in adults 50 years or older. Several areas described in this paper highlight the necessity for further research. Future studies could build on our findings. International and national initiatives may find our paper useful as a common European reference. ► Prevention of fragility fractures is essential for good health in older age; osteoporosis and fractures are key issues that need to be considered. Especially vulnerable patient groups, for example, frail older people, and those with cognitive impairments will benefit from European standards regarding interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. ► Implementation will be supported by national organisations, professional and scientific societies, including patient leagues.
Falls and Fractures: A systematic approach to screening and prevention
Maturitas, 2015
Falls are one of the major causes of mortality and morbidity in older adults. Every year, an estimated 30-40% of patients over the age of 65 will fall at least once. Falls lead to moderate to severe injuries, fear of falling, loss of independence and death in a third of those patients. Falls account for 87 % of all fractures in the elderly. These fractures are almost always due to low impact injuries in osteoporotic bones. Several organizations have recommended screening older patients to identify those with a high risk of falling and, or fractures. The present review provides a brief summary and update of the relevant literature, summarizing screening tools and interventions to prevent falls and fractures. The major risk factors identified are impaired balance and gait, polypharmacy, and history of previous falls. Other risk factors include advancing age, female gender, visual impairments, cognitive decline especially attention and executive dysfunction, and environmental factors. Recommendations for the clinician to screen and prevent falls in older patients are also summarized.
Archives of Gerontology and Geriatrics, 2006
Hip fractures are associated with considerable morbidity and mortality in the elderly. Both fall prevention strategies and bone integrity/osteoporosis assessment should be addressed in this population. This study's goal was to evaluate the management of potential re-fracture risk after a hip fracture in an acute care setting. This was a retrospective chart review of patients who were admitted with a hip fracture over the course of one year to the Ottawa Hospital, Civic Campus, Ottawa, Canada. The charts of 147 patients with hip fractures met the inclusion criteria. Use of sedatives on admission was significant (24.5%). Fifty (34%) had some form of osteoporosis management ordered during their hospital stay. The medication recommendations consisted of only 14% being prescribed Vitamin D and 15.6% being prescribed calcium supplementation. Merely 7 (4.8%) patients of the total sample were prescribed bisphosphonates at time of discharge. This study documents a significant care gap in refracture management at the time of acute hospitalization after an acute hip fracture. Interventions are required to increase the awareness that this problem is not being addressed at the time of hospitalization and that on discharge, patients will need follow-up by the treating community physician. #
Fracture prevention service to bridge the osteoporosis care gap
Clinical Interventions in Aging, 2015
Background: A care gap exists between the health care needs of older persons with fragility fractures and the therapeutic answers they receive. The Fracture Prevention Service (FPS), a tailored in-hospital model of care, may effectively bridge the osteoporosis care gap for hipfractured older persons. The purpose of this study was to evaluate the efficacy of the FPS in targeting persons at high risk of future fracture and to improve their adherence to treatment. Methods: This was a prospective observational study conducted in a teaching hospital with traumatology and geriatric units, and had a pre-intervention and post-intervention phase. The records of 172 participants were evaluated in the pre-intervention phase, while data from 210 participants were gathered in the post-intervention phase. All participants underwent telephone follow-up at 12 months after hospital discharge. The participants were patients aged 65 years admitted to the orthopedic acute ward who underwent surgical repair of a proximal femoral fracture. A multidisciplinary integrated model of care was established. Dedicated pathways were implemented in clinical practice to optimize the identification of high-risk persons, improve their evaluation through bone mineral density testing and blood examinations, and initiate an appropriate treatment for secondary prevention of falls and fragility fractures. Results: Compared with the pre-intervention phase, more hip-fractured persons received bone mineral density testing (47.62% versus 14.53%, P0.0001), specific pharmacological treatments (48.51% versus 17.16%, P0.0001), and an appointment for evaluation at a fall and fracture clinic (52.48% versus 2.37%, P0.0001) in the post-intervention phase. Independent of some confounders, implementation of the FPS was positively associated with recommendations for secondary fracture prevention at discharge (P0.0001) and with 1-year adherence to pharmacological treatment (P0.0001). Conclusion: The FPS is an effective multidisciplinary integrated model of care to optimize identification of older persons at highest risk for fragility fracture, to improve their clinical management, and to increase adherence to prescriptions.
Epidemiology, clinical significance, costs and fall prevention in elderly people
Ortopedia, traumatologia, rehabilitacja
Falls are the fifth most frequent cause of death among elderly people. They are one of the main causes of disability and reduction in the quality of life in this age group. Falls are the direct cause of the majority of limb and femoral neck fractures. Fall prevention is a difficult, expensive and underestimated problem in Poland. 30-40% of women aged 65 years or older experience a fall at least once a year. Falls lead directly to fractures in 5% of those living on their own and 20% of hospital inpatients. Underlying a fall are dysfunctions of multiple organs and the influence of external factors. About 400 different fall risk factors have been described. It has been demonstrated that the risk of falls can be decreased by as much as 40% provided that the patient is treated by a multidisciplinary team of specialists. Standard procedures of care have already been developed in Europe and in the world. This paper presents current knowledge on the epidemiology, significance and costs of t...
Calcified Tissue International, 2005
We have assessed the acceptability of a method for screening for risk of future hip fracture in elderly women. After receipt of an initial response to a mailed risk-factor questionnaire sent out to 5,306 women, women were randomly assigned to active or control groups. The active group was invited to participate in a screening visit that comprised a life-style questionnaire and a quantitative ultrasound heel scan. General practitioners (GPs) of women who were found to be in the lowest quartile of broadband ultrasound attenuation and/or who had two or more risk factors for hip fracture were advised to prescribe a calcium and vitamin D supplement. A second mailed questionnaire was sent to both groups 1 to 3 years later. Compared with the control group, the active group had a 56% lower risk of fracture (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.24-0.81 adjusted age, weight, and treatment status). At follow-up, the proportion of fallers in the active group (25.3%) was lower than that in the control group (29.6%) (P = 0.064). The control group was found to have a higher rate of falls at follow-up than the active group (95% CI, 0.02-0.22); no difference was found at baseline (95% CI, )0.08 to +0.14). The screening method used was found to be acceptable to the majority of elderly women in this study. Screening the elderly in this way together with simple advice on treatment appears to reduce the age-associated increase in fall rates and the number of subsequent fractures. This form of screening may provide a cost-effective method to reduce falls and fractures in free-living elderly women. However, no such cost-effectiveness analysis has been performed to date.
Journal of Clinical Medicine
Osteoporosis leads to increased risk of falls, and thus an increase in fractures, highlighting here hip fractures, that result in high mortality, functional disability, and high medical expenditure. The aim is to summarise the available evidence on effective non-pharmacological interventions to prevent the triad osteoporosis/falls risk/hip fracture. A scoping review was conducted consulting the Scientific Electronic Library Online (Scielo), National Institute for Health and Care Excellence (NICE), Cumulative Index to Nursing & Allied Health Literature (CINAHL) y PubMed.databases. Inclusion criteria were articles published between 2013 and 2019, in Spanish or English. In addition, publications on a population over 65 years of age covering non-pharmacological interventions aimed at hip fracture prevention for both institutionalised patients in long-stay health centres or hospitals, and patients cared for at home, both dependent and non-dependent, were included. Sixty-six articles were...