How to implement guidelines and models of care

In subjects older than 50 years, the presence of clinical risk factors (CRFs) for fractures or a recent fracture is the cornerstone for case finding. In patients who are clinically at high short- and long-term risk of fractures (those with a recent clinical fracture or with multiple CRFs), further a...

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Bibliographic Details
Published in:	Best practice & research. Clinical rheumatology 2022-09, Vol.36 (3), p.101759-101759, Article 101759
Main Authors:	Geusens, Piet, Appelman-Dijkstra, Natasha M., Carola Zillikens, M., Willems, Hanna, Lems, Willem F., van den Bergh, Joop
Format:	Article
Language:	eng
Subjects:	Absorptiometry, Photon - adverse effects Absorptiometry, Photon - methods Anabolic drugs Anti-resorptive drugs Bone Density Bone mineral density Fall risk Fracture prevention strategy Fracture risk Guideline implementation Humans Osteoporosis - complications Osteoporosis - diagnosis Osteoporosis - therapy Osteoporotic Fractures - diagnosis Osteoporotic Fractures - etiology Osteoporotic Fractures - prevention & control Spinal Fractures Vertebral fracture assessment
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Summary:	In subjects older than 50 years, the presence of clinical risk factors (CRFs) for fractures or a recent fracture is the cornerstone for case finding. In patients who are clinically at high short- and long-term risk of fractures (those with a recent clinical fracture or with multiple CRFs), further assessment with bone mineral density (BMD) measurement using dual-energy absorptiometry (DXA), imaging of the spine, fall risk evaluation and laboratory examination contributes to treatment decisions according to the height and modifiability of fracture risk. Treatment is available with anti-resorptive and anabolic drugs, and from the start of treatment a lifelong strategy is needed to decide about continuous, intermittent, and sequential therapy. Implementation of guidelines requires further initiatives for improving case finding, public awareness about osteoporosis and national policies on reimbursement of assessment and therapy.
ISSN:	1521-6942 1532-1770