EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures

Abstract

The European League Against Rheumatism (EULAR) and the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) have recognised the importance of optimal acute care for the patients aged 50 years and over with a recent fragility fracture and the prevention of subsequent fractures in high-risk patients, which can be facilitated by close collaboration between orthopaedic surgeons and rheumatologists or other metabolic bone experts. Therefore, the aim was to establish for the first time collaborative recommendations for these patients. According to the EULAR standard operating procedures for the elaboration and implementation of evidence-based recommendations, 7 rheumatologists, a geriatrician and 10 orthopaedic surgeons met twice under the leadership of 2 convenors, a senior advisor, a clinical epidemiologist and 3 research fellows. After defining the content and procedures of the task force, 10 research questions were formulated, a comprehensive and systematic literature search was performed and the results were presented to the entire committee. 10 recommendations were formulated based on evidence from the literature and after discussion and consensus building in the group. The recommendations included appropriate medical and surgical perioperative care, which requires, especially in the elderly, a multidisciplinary approach including orthogeriatric care. A coordinator should setup a process for the systematic investigations for future fracture risk in all elderly patients with a recent fracture. High-risk patients should have appropriate non-pharmacological and pharmacological treatment to decrease the risk of subsequent fracture.

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

“…(4)(5)(6)(7)(8)(9)(10)(11) FLS programs are cost-effective or cost-saving in several different practice settings, (8) and have been broadly and successfully adopted internationally. A substantial, growing body of literature demonstrates that the most effective organizational approach to secondary fracture prevention is a multidisciplinary case management approach that frequently takes the form of a fracture liaison service (FLS).…”

“…5. If pharmacologic therapy is not provided during hospitalization, then mechanisms should be in place to ensure timely follow-up.…”

“…(25,31) Most patients do not realize that they are at risk for another fracture, that osteoporosis caused their fracture, and that interventions can reduce their risk. (4,5) These messages also should be communicated to family/caregivers. (33) To communicate riskrelated messages effectively, all health care professionals should provide consistent and sustained messaging throughout the care pathway, beginning at time of diagnosis and continuing repeatedly.…”

“…The safe upper limit is also a matter of debate, and there is substantial disagreement over whether to treat to a specified serum level. (5,21) Calcium is critical for bone mineralization and strength. (87) The effect of vitamin D alone on the risk of fracture is not clear, (19,21) although there is strong evidence that it does reduce fractures when combined with calcium supplements in individuals at high risk of deficiency.…”

Guidelines for the diagnosis and management of osteoporosis in Poland : Update 2017

“…It should be stressed that each previous lowenergy fracture in the hip region and in other major locations highly increases the risk of subsequent fractures and is an absolute indication for fast initiation of comprehensive treatment (orthopaedic, pharmacological, analgesic, rehabilitation, and dietary interventions) [6].…”