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Combined EFORT-EULAR task force developed recommendations for fragility fracture care
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EFORT and the EULAR united efforts in a combined task force to create an evidence-based collaborative recommendationon for the management of fragility fractures and the prevention of subsequent fractures.
Karsten Dreinhöfer, MD, professor of orthopedics at Charité and Medical Park Humboldtmühle in Berlin and Willem Lems, MD, PhD, professor for rheumatology at University Medical Center in Amsterdam coordinated this task force. After a systematic literature review, experts including orthopedic surgeons, rheumatologists, geriatricians and epidemiologists from 14 countries derived 10 recommendations, which are briefly summarized below:
- Fragility fractures should be managed in a multidisciplinary clinical system;
- Orthogeriatric co-management should be given, especially for elderly patients with hip fractures;
- Treatment requires a balanced approach in terms of operative vs. nonoperative treatment with careful selection of fixation devices and techniques;
- Each patient with a recent fracture should be evaluated systematically for risk of subsequent fractures;
- To evaluate the risk for subsequent fracture, physicians can review clinical risk factors; use dual-energy X-ray absorptiometry on the hip or spine; image the spine for vertebral fracture; evaluate the risk for falls; and identify secondary osteoporosis;
- Implementation requires a local lead, a person or group that coordinates secondary fracture prevention with guidelines and establishes a working relationship between surgeons, rheumatologists, endocrinologists, geriatricians and general practitioners;
- Rehab programs should consist of early introduction of physical training and muscle strengthening and long-term continuation of balance training and multidimensional fall prevention;
- Patients should be educated about follow-up, disease burden, fracture risk factors and therapy duration;
- Non-pharmacologic treatment includes smoking cessation, limitation of alcohol and consumption of enough vitamin D and calcium; and
- Pharmacological treatment should use drugs demonstrated to reduce risk for vertebral, non-vertebral and hip fractures and patients should be monitored regularly for tolerance and adherence.
“This combined EULAR/EFORT task force was characterized by intensive discussions between orthopedic surgeons and rheumatologists, which strongly increased insight into the thoughts and behaviors of each specialty,” Lems and Dreinhöfer wrote. “We hope that the manuscript will stimulate work between these specialties with fracture patients, both in daily practice and in research projects.” – by Will A. Offit
Disclosures: Lems reports he received personal fees from Amgen, Eli Lilly, Novartis and Merck, Dreinhöfer reports he received personal fees from Agnovos, Amgen, Eli Lilly, Merck, Sanofi and UCB.
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