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RMD Open. 2020 Jan;6(1). pii: e001143. doi: 10.1136/rmdopen-2019-001143.

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

Author information

1
School of Health Sciences, University of Southampton, Southampton, Hampshire, UK.
2
Department Social Affaire and Health, ECORYS Nederland BV, Rotterdam, Zuid-Holland, Netherlands.
3
EULAR Standing Committee of People with Arthritis/Rheumatism in Europe, Zurich, Switzerland.
4
EULAR Young PARE, Zurich, Switzerland.
5
Slovak League Against Rheumatism, Piestany, Slovakia.
6
Medicine for Older People, University Hospital Southampton, Southampton, UK.
7
Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
8
INSERM U1153, Paris Descartes University, Reference Center for Genetic Bone Diseases, Department of Rheumatology, Cochin Hospital, Paris, France.
9
Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Wien, Austria.
10
Department of Balneology, Rehabilitation and Rheumatology, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania.
11
Department of Rheumatology, VU University Medical Centre Amsterdam, Amsterdam, Noord-Holland, Netherlands.
12
Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
13
School of Health (ESSUAlg), University of Algarve, Faro, Portugal.
14
Department of Internal Medicine 3, Division of Rheumatology, Medical University Vienna, Vienna, Austria.
15
Trauma & Orthopaedics, University Hospital Southampton, Southampton, UK.
16
Centre for Biomedical Research, Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.
17
Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria tanja.stamm@meduniwien.ac.at.

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.

KEYWORDS:

health services research; multidisciplinary team-care; osteoporosis

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