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Prevention and management of osteoporotic fractures by non-physician health professionals: A systematic literature review to inform EULAR points to consider

Prevention and management of osteoporotic fractures by non-physician health professionals: A systematic literature review to inform EULAR points to consider
Prevention and management of osteoporotic fractures by non-physician health professionals: A systematic literature review to inform EULAR points to consider

Objective To perform a systematic literature review (SLR) about the effect of non-pharmacological interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. Methods Eight clinical questions based on two criteria guided the SLR: (1) adults≥50 years at high risk of osteoporotic fracture and (2) interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. Interventions focused on diagnostic procedures to identify risk of falling, therapeutic approaches and implementation strategies. Outcomes included fractures, falls, risk of falling and change in bone mineral density. Systematic reviews and randomised controlled trials were preferentially selected. Data were synthesised using a qualitative descriptive approach. Results Of 15 917 records, 43 articles were included. Studies were clinically and methodologically diverse. We identified sufficient evidence that structured exercise, incorporating progressive resistance training delivered to people who had undergone hip fracture surgery, and multicomponent exercise, delivered to people at risk of primary fracture, reduced risk of falling. The effectiveness of multidisciplinary fracture liaison services in reducing refracture rate was confirmed. There was insufficient evidence found to support the effectiveness of nutrients and falls prevention programmes in this patient population. Conclusion Despite study heterogeneity, our SLR showed beneficial effects of some interventions delivered by non-physician health professionals and the positive impact of multidisciplinary team working and patient educational approaches to prevent and manage osteoporotic fractures. These results informed a EULAR taskforce that developed points to consider for non-physician health professionals to prevent and manage osteoporotic fractures.

health services research, multidisciplinary team-care, osteoporosis
2056-5933
Wilson, N.
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Hurkmans, E.J.
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Adams, J.
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Bakkers, M.
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Balážová, P.
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Baxter, M.
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Blavnsfeldt, A.
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Briot, K.
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Chiari, C.
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Cooper, C.
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Dragoi, R.G.
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Gäbler, G.
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Lems, W.F.
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Mosor, E.
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Pais, S.
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Simon, C.
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Studenic, P.
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Tilley, S.
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de la Torre, J.
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Stamm, T.
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Wilson, N.
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Hurkmans, E.J.
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Adams, J.
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Bakkers, M.
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Balážová, P.
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Baxter, M.
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Blavnsfeldt, A.
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Briot, K.
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Chiari, C.
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Cooper, C.
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Dragoi, R.G.
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Gäbler, G.
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Lems, W.F.
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Mosor, E.
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Pais, S.
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Simon, C.
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Studenic, P.
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Tilley, S.
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de la Torre, J.
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Stamm, T.
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Wilson, N., Hurkmans, E.J., Adams, J., Bakkers, M., Balážová, P., Baxter, M., Blavnsfeldt, A., Briot, K., Chiari, C., Cooper, C., Dragoi, R.G., Gäbler, G., Lems, W.F., Mosor, E., Pais, S., Simon, C., Studenic, P., Tilley, S., de la Torre, J. and Stamm, T. (2020) Prevention and management of osteoporotic fractures by non-physician health professionals: A systematic literature review to inform EULAR points to consider. RMD Open, 6 (1), [e001143]. (doi:10.1136/rmdopen-2019-001143).

Record type: Article

Abstract

Objective To perform a systematic literature review (SLR) about the effect of non-pharmacological interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. Methods Eight clinical questions based on two criteria guided the SLR: (1) adults≥50 years at high risk of osteoporotic fracture and (2) interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. Interventions focused on diagnostic procedures to identify risk of falling, therapeutic approaches and implementation strategies. Outcomes included fractures, falls, risk of falling and change in bone mineral density. Systematic reviews and randomised controlled trials were preferentially selected. Data were synthesised using a qualitative descriptive approach. Results Of 15 917 records, 43 articles were included. Studies were clinically and methodologically diverse. We identified sufficient evidence that structured exercise, incorporating progressive resistance training delivered to people who had undergone hip fracture surgery, and multicomponent exercise, delivered to people at risk of primary fracture, reduced risk of falling. The effectiveness of multidisciplinary fracture liaison services in reducing refracture rate was confirmed. There was insufficient evidence found to support the effectiveness of nutrients and falls prevention programmes in this patient population. Conclusion Despite study heterogeneity, our SLR showed beneficial effects of some interventions delivered by non-physician health professionals and the positive impact of multidisciplinary team working and patient educational approaches to prevent and manage osteoporotic fractures. These results informed a EULAR taskforce that developed points to consider for non-physician health professionals to prevent and manage osteoporotic fractures.

Text
Prevention and management of osteoporotic fractures by non-physician health professionals A systematic literature review to inform European League Against Rheumatism (EULAR) points to consider - Accepted Manuscript
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Accepted/In Press date: 5 February 2020
e-pub ahead of print date: 5 March 2020
Published date: 5 March 2020
Additional Information: Funding Information: Contributors all authors discussed and formulated the clinical questions and interpreted the results. nW, Ja, eh and Tas collected the data, performed the analysis and wrote the manuscript. all authors read and critically reviewed the manuscript prior to submission. Funding This study was funded by the eUlar. grant reference hPr 032. Competing interests none declared. Publisher Copyright: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: health services research, multidisciplinary team-care, osteoporosis

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Local EPrints ID: 437963
URI: http://eprints.soton.ac.uk/id/eprint/437963
ISSN: 2056-5933
PURE UUID: 4e969891-8534-40b9-8ffd-e62712b81b62
ORCID for N. Wilson: ORCID iD orcid.org/0000-0001-7404-7360
ORCID for J. Adams: ORCID iD orcid.org/0000-0003-1765-7060
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 24 Feb 2020 17:31
Last modified: 07 Sep 2022 04:01

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Contributors

Author: N. Wilson ORCID iD
Author: E.J. Hurkmans
Author: J. Adams ORCID iD
Author: M. Bakkers
Author: P. Balážová
Author: M. Baxter
Author: A. Blavnsfeldt
Author: K. Briot
Author: C. Chiari
Author: C. Cooper ORCID iD
Author: R.G. Dragoi
Author: G. Gäbler
Author: W.F. Lems
Author: E. Mosor
Author: S. Pais
Author: C. Simon
Author: P. Studenic
Author: S. Tilley
Author: J. de la Torre
Author: T. Stamm

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