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Original research
Prevention and management of osteoporotic fractures by non-physician health professionals: a systematic literature review to inform EULAR points to consider
  1. Nicky Wilson1,
  2. Emailie Hurkmans2,
  3. Jo Adams1,
  4. Margot Bakkers3,
  5. Petra Balážová4,5,
  6. Mark Baxter6,
  7. Anne-Birgitte Blavnsfeldt7,
  8. Karine Briot8,
  9. Catharina Chiari9,
  10. Cyrus Cooper1,
  11. Razvan Dragoi10,
  12. Gabriele Gäbler9,
  13. Willem Lems11,
  14. Erika Mosor12,
  15. Sandra Pais13,
  16. Cornelia Simon10,
  17. Paul Studenic14,
  18. Simon Tilley15,
  19. Jenny de la Torre16 and
  20. Tanja A Stamm17
  1. 1School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
  2. 2Department Social Affaire and Health, ECORYS Nederland BV, Rotterdam, Zuid-Holland, Netherlands
  3. 3EULAR Standing Committee of People with Arthritis/Rheumatism in Europe, Zurich, Switzerland
  4. 4EULAR Young PARE, Zurich, Switzerland
  5. 5Slovak League Against Rheumatism, Piestany, Slovakia
  6. 6Medicine for Older People, University Hospital Southampton, Southampton, UK
  7. 7Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
  8. 8INSERM U1153, Paris Descartes University, Reference Center for Genetic Bone Diseases, Department of Rheumatology, Cochin Hospital, Paris, France
  9. 9Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Wien, Austria
  10. 10Department of Balneology, Rehabilitation and Rheumatology, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
  11. 11Department of Rheumatology, VU University Medical Centre Amsterdam, Amsterdam, Noord-Holland, Netherlands
  12. 12Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
  13. 13School of Health (ESSUAlg), University of Algarve, Faro, Portugal
  14. 14Department of Internal Medicine 3, Division of Rheumatology, Medical University Vienna, Vienna, Austria
  15. 15Trauma & Orthopaedics, University Hospital Southampton, Southampton, UK
  16. 16Centre for Biomedical Research, Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
  17. 17Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
  1. Correspondence to Dr Tanja A Stamm; tanja.stamm{at}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.

  • osteoporosis
  • multidisciplinary team-care
  • health services research
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • NW and EH are joint first authors.

  • Contributors All authors discussed and formulated the clinical questions and interpreted the results. NW, JA, EH and TAS collected the data, performed the analysis and wrote the manuscript. All authors read and critically reviewed the manuscript prior to submission.

  • Funding This study was funded by the EULAR. Grant reference HPR 032.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study.

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