RT Journal Article
SR Electronic
T1 Prevention and management of osteoporotic fractures by non-physician health professionals: a systematic literature review to inform EULAR points to consider
JF RMD Open
JO RMD Open
FD EULAR
SP e001143
DO 10.1136/rmdopen-2019-001143
VO 6
IS 1
A1 Nicky Wilson
A1 Emailie Hurkmans
A1 Jo Adams
A1 Margot Bakkers
A1 Petra Balážová
A1 Mark Baxter
A1 Anne-Birgitte Blavnsfeldt
A1 Karine Briot
A1 Catharina Chiari
A1 Cyrus Cooper
A1 Razvan Dragoi
A1 Gabriele Gäbler
A1 Willem Lems
A1 Erika Mosor
A1 Sandra Pais
A1 Cornelia Simon
A1 Paul Studenic
A1 Simon Tilley
A1 Jenny de la Torre
A1 Tanja A Stamm
YR 2020
UL http://rmdopen.bmj.com/content/6/1/e001143.abstract
AB 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.