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Ann Rheum Dis. 2017 May;76(5):802-810. doi: 10.1136/annrheumdis-2016-210289. Epub 2016 Dec 22.

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

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Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands.
Department of Orthopedics and Traumatology, Center for Musculoskeletal Surgery (CMSC), Charité Universitätsmedizin Berlin Medical Park Berlin Humboldtmühle, Berlin, Germany.
Departemnt of Geriatrics and Aging Research, University Hospital and University of Zurich, Zurich, Switzerland.
Department for Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria.
Department of Bone and Joint Diseases, Jagiellonian University, Faculty of Health and Sciences, Krakow Medical Centre, Krakow, Poland.
Department of Rheumatology, Faculdade de Medicina e Centro Hospitalar, Universidade de Coimbra, Coimbra, Portugal.
Department of Surgery, University of Zaragoza, Zaragosa, Spain.
Department of Surgery, Division of Orthopaedics, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
Faculty of Medicine, St. Joseph University, Bellevue University Medical Center, Beirut, Lebanon.
University College London, London, UK.
Department of Orthopaedic Surgery, Hopital Rangueil, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
Past President EFORT, University Ulm, Germany.
Department of Internal Medicine III, National Institute of Rheumatology and Physiotherapy, Rheumatology Chair, Semmelweis University, Budapest, Hungary.
Department of Rheumatology, INSERM 1153, Cochin Hospital, Paris Descartes University, Paris, France.
Research Laboratory and Academic, Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy.
Department of Orthopedics and Traumatology, Tor Vergata University of Rome, Rome, Italy.
Department of Family Medicine, Maastricht University, CAPHRI-School for Public Health and Primary Care, Maastricht, The Netherlands.
Bone and Joint Research Group, Knowledge Spa, Royal Cornwall Hospital, Truro, UK.
Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands.
Department of Internal Medicine, Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.
University Hasselt, Hasselt, Belgium.


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.


Bone Mineral Density; Orthopedic Surgery; Osteoporosis

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