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

EULAR points to consider / recommendations for the health professionals' prevention and management of osteoporotic fractures
EULAR points to consider / recommendations for the health professionals' prevention and management of osteoporotic fractures
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.
0003-4967
1790
Hurkmans, E.
8e1ef4c2-871e-4277-ba8a-766233fd99c8
Wilson, Nicola
84a5fdb8-8e0c-4b7c-ae30-5fa3751421f4
Stamm, T.
c5bb532e-64aa-41a1-8c0b-179f7481352d
Adams, Joanna
6e38b8bb-9467-4585-86e4-14062b02bcba
Hurkmans, E.
8e1ef4c2-871e-4277-ba8a-766233fd99c8
Wilson, Nicola
84a5fdb8-8e0c-4b7c-ae30-5fa3751421f4
Stamm, T.
c5bb532e-64aa-41a1-8c0b-179f7481352d
Adams, Joanna
6e38b8bb-9467-4585-86e4-14062b02bcba

Hurkmans, E., Wilson, Nicola, Stamm, T. and Adams, Joanna (2018) EULAR points to consider / recommendations for the health professionals' prevention and management of osteoporotic fractures. Annals of the Rheumatic Diseases, 77 (S2), 1790. (doi:10.1136/annrheumdis-2018-eular.4821).

Record type: Meeting abstract

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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EULAR 2018 THU0725-HPR EULAR points to consider / recommendations for the health professionals' prevention and management of osteoporotic fractures - Version of Record
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More information

Published date: 14 June 2018
Venue - Dates: Annual European Congress of Rheumatology EULAR 2018, Amsterdam, Netherlands, 2018-06-13 - 2018-06-16

Identifiers

Local EPrints ID: 422151
URI: https://eprints.soton.ac.uk/id/eprint/422151
ISSN: 0003-4967
PURE UUID: ab6c0f50-6cba-44b1-86de-579362e008f6
ORCID for Nicola Wilson: ORCID iD orcid.org/0000-0001-7404-7360
ORCID for Joanna Adams: ORCID iD orcid.org/0000-0003-1765-7060

Catalogue record

Date deposited: 18 Jul 2018 16:30
Last modified: 18 May 2019 00:38

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Contributors

Author: E. Hurkmans
Author: Nicola Wilson ORCID iD
Author: T. Stamm
Author: Joanna Adams ORCID iD

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