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10 recommendations describe how health care providers should work together to care for adults 50 years of age or older with fragility fractures and to prevent future fractures

Lems WF, Dreinhofer KE, Bischoff-Ferrari H, et al. EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures. Ann Rheum Dis. 2016 Dec 22. Epub ahead of print.

Guideline question

In adults 50 years of age or older with fragility fractures, what are the recommendations from the European League Against Rheumatism (EULAR) and the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) for preventing future fractures?


A fragility fracture is a fracture (broken bone) that results from a fall from a low height (standing height or less). A fragility fracture is often a sign that the bones are fragile, usually due to osteoporosis (a disease that causes a breakdown of bone tissue).

People older than 50 years who have fragility fractures generally need health care from more than one medical specialty, including surgeons, rheumatologists and bone specialists, general practitioners, and rehab specialists. These specialists need to work closely together.

How the review was done

The researchers agreed on the 10 most important questions for treating people with fragility fractures and preventing future fractures. They did a systematic review, searching for studies related to those 10 questions. A group of experts participated in an in-depth process that involved repeatedly reviewing the results of the systematic review, formulating and revising recommendations, assessing agreement of recommendations, incorporating feedback from experts outside the group, and evaluating the strength of each recommendation.

What the researchers found

The 10 recommendations from the group are shown in the Table below.


10 recommendations describe how health care providers from different specialties should work together to care for adults 50 years of age or older with fragility fractures and to prevent future fractures.

Recommendations for people 50 years of age or older with fragility fractures


Doctors from different specialties should manage treatment of fragility fractures to ensure people have

  • surgery within 48 hours of injury; and
  • adequate assessment and preparation before surgery, including pain relief and fluid management.

Doctors who specialize in treatment of elderly people (e.g., geriatricians) should be involved in care, especially for elderly people with hip fractures.

Treatment of fractures requires balancing the risks and benefits of different options for surgery and other treatments.

All people should be carefully assessed for their risk for future fractures.

Assessment of risk for future fractures includes:

  • review of clinical risk factors;
  • bone densitometry of the spine and hip;
  • imaging of the spine for fractures in the vertebra ;
  • assessment of risk for falls; and
  • identification of osteoporosis.

One health care professional should be responsible for:

  • coordinating care by surgeons and other doctors; and
  • ensuring that guidelines are followed for preventing additional fractures.

Rehabilitation should include:

  • physical training and muscle strengthening early after the fracture; and
  • long-term balance training and fall prevention.

People should be taught about their illness, risk factors for fractures, and treatments.

Non-drug treatments are important for preventing future fractures in people at high risk, and include:

  • adequate intake of calcium and vitamin D;
  • quitting smoking; and
  • limited alcohol intake.

Drugs that are known to reduce risk of vertebral, nonvertebral, and hip fractures should be used. Tolerance and adherence to drugs should be monitored by doctors.



Risk factors
Aspects making a condition more likely.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Web Resources

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    Health Link B.C.
    Osteoporosis Canada recommends everyone over age 65 have routine bone density tests. Start routine testing earlier if you are at increased risk for broken bones. Use the FRAX tool to predict your risk of having a fracture related to osteoporosis (link in this resource).
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