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.
Ann Rheum Dis. 2017 May;76(5):802-810. doi: 10.1136/annrheumdis-2016-210289. Epub 2016 Dec 22.
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.
欧洲抗风湿病联盟（EULAR）和欧洲骨科和创伤学联合会（EFORT）认识到，为 50 岁及以上近期脆性骨折患者提供最佳急性护理以及为高风险患者预防后续骨折的重要性，这可以通过骨科医生和风湿病学家或其他代谢性骨病专家之间的密切合作来实现。因此，目的是首次为这些患者制定协作建议。根据 EULAR 制定和实施循证建议的标准操作程序，7 名风湿病学家、一名老年病学家和 10 名骨科医生在 2 名召集人的领导下两次开会，召集人由一名高级顾问、一名临床流行病学家和 3 名研究人员组成。在定义工作组的内容和程序后，制定了 10 个研究问题，进行了全面和系统的文献检索，并将结果提交给全体委员会。根据文献中的证据，并在小组内进行讨论和达成共识后，制定了 10 项建议。建议包括适当的医疗和手术围手术期护理，这尤其需要包括骨科老年病护理在内的多学科方法。协调员应为所有近期骨折的老年患者建立一个系统的未来骨折风险调查流程。高风险患者应接受适当的非药物和药物治疗，以降低后续骨折的风险。
