2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older (original) (raw)

2020, Annals of the Rheumatic Diseases

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.