EULAR points to consider / recommendations for the health professionals' prevention and management of osteoporotic fractures

Abstract

Background Interventions delivered by non-physician health professionals, such as physiotherapists, occupational therapists and nurses play an important role in effective management of patients with osteopenia or osteoporosis.

Objectives To establish EULAR Points to Consider/Recommendations for the prevention and management of osteoporotic fractures by non-physician health professionals.

Methods Points to consider/recommendations were developed according to EULAR standard procedures1 using six stages: i) establishment of an international expert panel/task force including patients, rheumatologists, orthopaedic surgeons and health professionals; ii) a first Delphi-round to set up clinical questions; iii) a literature review; iv) a task force meeting to review the results of the literature search and to formulate points to consider/recommendations; v) development of consensus and assessment of the level of agreement with the points to consider/recommendations using second Delphi round; vi) a field test.

Results Eight clinical questions and two overarching principles were formulated, subject to the literature search (the clinical questions only) and discussed and refined during the task force meeting. The two overarching principles focused on the importance of shared decision making between patients and professionals and the involvement of different health professionals. Two clinical questions were merged and the task force finally agreed on seven recommendations/points to consider: 1) Health professionals should start with fall risk evaluation in patients at risk of primary or secondary fracture. Patients with high risk should be evaluated by a health professional using multi-component screening, or referred to another health professional competent in multi-component screening. 2) Health professionals should ensure that after osteoporotic fracture, patients are given opportunities to participate in adequate exercise and are supported in adequate nutritional intake. Calcium and vitamin D intake should be discussed with the patients. 3) Smoking and overuse of alcohol should be discouraged. 4) Tailored multicomponent interventions including, for example: exercises, environmental adaptations, nutrition, life-style and education, should be offered to patients at high risk of primary osteoporotic fracture and/or high risk of falls. 5) Health professionals should be included in Fracture Liaison Services (FLS) and/or a coordinated, multidisciplinary post-fracture prevention program. Patients with fragility fractures should be referred to a FLS or an adequate, coordinated, multidisciplinary post-fracture prevention program. 6) Health professionals should address, monitor and support medication adherence in a structured follow up. 7) Health professionals should identify patients at risk of bone fragility, ensure they are offered opportunities for adequate treatment, and address bone fragility through patient education.

Conclusions These points to consider/recommendations should be applied by health professionals in the prevention and management of osteoporotic fracture to ensure high quality care.

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Identifiers

ORCID for Nicola Wilson: orcid.org/0000-0001-7404-7360

ORCID for Joanna Adams: orcid.org/0000-0003-1765-7060

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