EULAR: Nonphysician health providers should be part of fragility fracture management
Nonphysician health professionals should discuss adequate nutrition, including daily recommended calcium and vitamin D intake, with patients aged 50 years and older to help prevent and manage fragility fractures, according to new EULAR “points to consider” published in the Annals of the Rheumatic Diseases.
“The European League Against Rheumatism (EULAR) Standing Committees recognize the importance of optimizing health care delivered by non-physician HPs to people at high-risk of fragility fractures,” Jo Adams, PhD, MSc, DipCOT, of the University of Southampton, in the United Kingdom, and colleagues wrote.
“The EULAR/EFORT (European Federation of National Associations of Orthopedics and Traumatology) recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fracture, focused primarily on physician-based interventions,” they added. “Interventions delivered by non-physician HPs were not comprehensively covered.”
To establish points to consider for nonphysician health professionals regarding the prevention and management of fragility fractures, Adams and colleagues formed an international, multidisciplinary task force. This task force included two patient research partners, one dietitian, one geriatrician, one nurse, three occupational therapists, two orthopedic surgeons, four physiotherapists, one specialist in physical medicine and rehabilitation, and five rheumatologists with expertise in osteoporosis. An email Delphi survey, followed by two rounds of voting, helped to develop and prioritize eight clinical questions.
These eight questions later informed a systematic literature review, based on the concepts of adults aged 50 years and older at high risk for osteoporotic fracture, and interventions provided by nonphysician health care professionals to prevent and manage such fractures. The task force met face-to-face to review the results of the review and later develop a series of overarching principles and points to consider. Points were finalized over a period of weeks through online discussion. Final voting was conducted via email, using a numerical rating scale from 0 to 10 to gauge agreement.
In all, the task force approved two overarching principles and seven points to consider. According to overarching principles, fragility fracture management should be based on shared decision making between the patient and nonphysician health professional. Nonphysicians also should be involved in the management of patients at risk for fragility fractures.
The seven points to consider urge nonphysician health providers to:
- Identify patients who are at risk for fragility fracture, and ensure they are given opportunities for adequate treatment and education;
- Begin with fall-risk evaluation for patients who are at risk for fragility fracture, using an individualized approach to multi-component screening;
- Offer individualized exercise, nutrition, education and environmental interventions to patients who are at high risk for osteoporotic fracture or falls;
- Counsel their patients to avoid smoking and the overuse of alcohol;
- Ensure patients with prior fragility fractures have opportunities for adequate exercise and nutrition, and discuss daily recommended calcium and vitamin D intake and supplementation;
- Refer patients with fragility fractures to a fracture liaison service for a coordinated, multidisciplinary post-fracture prevention program; and
- Monitor and support drug adherence during follow-up.
“The personal, societal and economic burdens associated with fragility fractures are enormous,” Adams and colleagues wrote. “These EULAR points to consider, based on robust development processes and agreed by an international task force, can guide non-physician HPs in the prevention and management of fragility fractures in adults 50 years or older.” – by Jason Laday
Disclosures: The researchers report funding from the NIH.