A comprehensive fracture prevention strategy in older adults: The European union geriatric medicine society (EUGMS) statement - 05/12/16

Doi : 10.1016/j.eurger.2016.04.012

H. Blain ^a,^⁎ , T. Masud ^b , P. Dargent-Molina ^c , F.C. Martin ^d , E. Rosendahl ^e , N. van der Velde ^f , J. Bousquet ^g , A. Benetos ^h , C. Cooper ^i,^j , J.A. Kanis ^k , J.Y. Reginster ^l , R. Rizzoli ^m , B. Cortet ⁿ , M. Barbagallo ^o , K. Dreinhöfer ^p,^q , B. Vellas ^r , S. Maggi ^s , T. Strandberg ^t,^u
for the International association of gerontology, geriatrics for the European region (IAGG-ER), the European union of medical specialists (EUMS), the Fragility fracture network (FFN)
for the EUGMS falls and fracture interest group
M.N. Alvarez ^v , C. Annweiler ^w,^x , P.-L. Bernard ^y , N. Beswetherick ^z , H.A. Bischoff-Ferrari ^aa , F. Bloch ^ab , J. Boddaert ^ac , M. Bonnefoy ^ad , V. Bousson ^ae , I. Bourdel-Marchasson ^af , A. Capisizu ^ag , H. Che ^ah , J.G. Clara ^ai , B. Combe ^aj , D. Delignieres ^y , P. Eklund ^ak , M. Emmelot-Vonk ^al , E. Freiberger ^am , J.-B. Gauvain ^an , N. Goswami ^ao , N. Guldemond ^ap , Á.C. Herrero ^aq , M.-E. Joël ^ar , A.B. Jónsdóttir ^as , G. Kemoun ^at , I. Kiss ^au , H. Kolk ^av , M.L. Kowalski ^aw , Š. Krajcík ^ax , Y.G. Kutsal ^ay , F. Lauretani ^az , J. Macijauskienė ^ba , M. Mellingsæter ^bb , J. Morel ^aj , F. Mourey ^bc , F. Nourashemi ^bd , C. Nyakas ^be , F. Puisieux ^bf , P. Rambourg ^bg , A.G. Ramírez ^bh , K. Rapp ^bi , Y. Rolland ^bj,^bk , J. Ryg ^bl , O. Sahota ^bm , S. Snoeijs ^bn , Y. Stephan ^bo , E. Thomas ^bp , C. Todd ^bq , J. Treml ^br
^v Department of geriatric medicine of Infanta, Sofia university hospital, S.S. Reyes, Madrid, Spain
^w Department of neuroscience, division of geriatric medicine, Angers university hospital, university memory clinic, UPRES EA 4638, UNAM, Angers, France
^x Robarts research institute, department of medical biophysics, Schulich school of medicine and dentistry, the university of Western Ontario, London, Ontario, Canada
^y UFR-STAPS, université Montpellier, EA 2991 EuroMov, Montpellier, France
^z OBE MBA FCSP, chartered society of physiotherapy, London, United Kingdom
^aa ESCEO/IOF, department of geriatrics and aging research, university hospital Zurich and university of Zurich, Zurich, Switzerland
^ab EA 4468, department of gerontology, hôpital Broca, AP–HP, university Paris-Descartes, Paris, France
^ac CNRS UMR8256, unit of perioperative geriatric care, geriatric department Pitié-Salpêtrière hospital, Pierre-et-Marie-Curie university, UPMC Paris 6, Paris, France
^ad Department of geriatrics, groupement hospitalier Sud, HCL université Claude-Bernard, unité Inserm 1060, 69495 Pierre-Bénite cedex, France
^ae Service de radiologie ostéoarticulaire, hôpital Lariboisière, GRIO, Paris, France
^af Clinical gerontology department, CHU de Bordeaux, RMSB, UMR 5536, CNRS, Bordeaux university, Bordeaux, France
^ag University of medicine and pharmacy “Carol Davila” geriatric department, “St Luke” hospital, Bucharest, Romania
^ah Département de rhumatologie, pôle os et articulations, hôpital Lapeyronie, université de Montpellier, Montpellier, France
^ai Department of internal medicine and geriatrics, clinical Sao Joao de deus, Libon, Portugal
^aj Société française de rhumatologie, département de rhumatologie, pôle os et articulations, hôpital Lapeyronie, université Montpellier I, Montpellier, France
^ak Department of computing science, Umeå university, SE-90187 Umeå, Sweden
^al Department of geriatrics, university medical centre Utrecht, Utrecht, The Netherlands
^am Institute for biomedicine of aging, Nürnberg, Germany
^an Court séjour gériatrique, GRIO, CHR d’Orléans, Orléans, France
^ao Institute of physiology, medical university of Graz, Graz, Austria
^ap University medical centre Utrecht, Utrecht, The Netherlands
^aq F.E.A Geriatría Complejo Hospitalario Navarra, Pamplona, Spain
^ar Université Paris-Dauphine, Paris, France
^as Department of geriatric medicine, The National university hospital of Iceland, Reykjavík, Iceland
^at Laboratoire EA 6314, université de Poitiers, institut de recherche sur le handicap et le vieillissement, Paris, France
^au Division section of geriatrics, 2nd department of internal medicine, Semmelweis university, Budapest, Hungary
^av Department of traumatology and orthopaedics, Tartu university hospital, Tartu, Estonia
^aw Department of immunology, rheumatology and allergy, medical university of Lodz, Lodz, Poland
^ax Geriatric department, Slovak Medical university, Bratislava, Slovakia
^ay University research center of geriatric sciences, Ankara, Turkey
^az University hospital of Parma, Parma, Italy
^ba Department of geriatrics, medical academy, Lithuanian university of health sciences, Kaunas, Lithuania
^bb Akershus university hospital, Lørenskog, Norway
^bc Inserm 1093, UFR santé université Bourgogne Franche-Comté, Bourgogne, France
^bd Gérontopôle de Toulouse, Toulouse, France
^be Semmelweis university, faculty of health sciences, research unit for behavioral physiology, Budapest, Hungary
^bf Département de gériatrie, CHU de Lille, Lille, France
^bg Pôle de pharmacie, CHU de Montpellier, Montpellier, France
^bh Working group of osteoporosis, falls and fractures of the Spanish geriatrics society, unit of geriatrics, universitary hospital of Salamanca, Salamanca, Spain
^bi Department of geriatrics and geriatric rehabilitation, Robert-Bosch hospital, Stuttgart, Germany
^bj Gérontopôle de Toulouse, institut du vieillissement, centre hospitalo-universitaire de Toulouse, Toulouse, France
^bk Unité mixe de recherche, Institut national de la santé et de la recherche médicale 1027, university of Toulouse III, Toulouse, France
^bl Department of geriatric medicine, Odense university hospital, department of clinical research, university of Southern Denmark, Odense, Southern Denmark
^bm Department of orthogeriatric medicine and consultant physician, QMC, Nottingham university hospitals NHS Trust, Nottingham, United Kingdom
^bn Department of care demand of the chronically ill and disabled international comparative health services research, Utrecht, The Netherlands
^bo EA 4556 dynamic of human abilities and health behaviors, university of Montpellier, Montpellier, France
^bp Departement de rhumatologie, pôle os et articulations, hôpital Lapeyronie, université de Montpellier, Montpellier, France
^bq School of nursing, midwifery and social work, university of Manchester, Manchester, United Kingdom
^br Co-Chair british geriatrics society falls and bone health section, department of geriatric medicine, Queen Elizabeth hospital, Birmingham, United Kingdom

for the European society for clinical and economic aspects of osteoporosis and osteoarthritis (ESCEO), osteoporosis research and information group (GRIO), and International osteoporosis foundation (IOF)
R. Adachi ^bs , D. Agnusdei ^bt , J.-J. Body ^bu , V. Breuil ^bv , O. Bruyère ^bw , P. Burckardt ^bx , J.B. Cannata-Andia ^by , J. Carey ^bz , D.-C. Chan ^ca,^cb , L. Chapuis ^cc , T. Chevalley ^cd , M. Cohen-Solal ^ce , B. Dawson-Hughes ^cf , E.M. Dennison ^cg , J.-P. Devogelaer ^ch , P. Fardellone ^ci , J.-M. Féron ^cj , A.D. Perez ^ck , D. Felsenberg ^cl , C. Glueer ^cm , N. Harvey ^cn , M. Hiligsman ^co , M.K. Javaid ^cp , N.R. Jörgensen ^cq,^cr , D. Kendler ^cs , M. Kraenzlin ^ct , M. Laroche ^cu , E. Legrand ^cv , W.D. Leslie ^cw , E. Lespessailles ^cx , E.M. Lewiecki ^cy , T. Nakamura ^cz , A. Papaioannou ^da , C. Roux ^db , S. Silverman ^dc , M.S. Henriquez ^dd,^de , T. Thomas ^df , S. Vasikaran ^dg , N.B. Watts ^dh , G. Weryha ^di
^bs Saint-Joseph's hospital, IOF, Western university, London, Ontario, Canada
^bt Skeletal diseases, IOF, Eli Lilly and Co., Sesto Fiorentino, Italy
^bu CHU Brugmann, ESCEO/IOF, université Libre de Bruxelles, Brussels, Belgium
^bv Nice university hospital, GRIO, Pasteur 2 hospital, department of rheumatology, UMR E-4320 TIRO-MATOs CEA/iBEB, Nice Sophia Antipolis university, Nice, France
^bw Department of public health, epidemiology and health economics, ESCEO/IOF, university of Liège, Liège, Belgium
^bx Hirslanden Bois Cerf, ESCEO/IOF, Lausanne, Switzerland
^by Bone and mineral research unit, hospital Universitario Central de Asturias, universidad de Oviedo, ESCEO/IOF, Oviedo, Spain
^bz Department of rheumatology, ESCEO/IOF, Galway university hospitals, National university of Ireland Galway, Galway, Republic of Ireland
^ca Department of gerontology and geriatrics, National Taiwan university hospital, Taipei, Taiwan
^cb Department of internal medicine, IOF, National Taiwan, Taipei, Taiwan
^cc Service de rhumatologie, GRIO, 35500 Vitré, France
^cd Division of bone diseases, university hospitals and faculty of medicine, ESCEO/IOF, Geneva, Switzerland
^ce Inserm U1132 & USPC Paris-Diderot, department of rheumatology, hôpital Lariboisière, GRIO, Paris, France
^cf Jean-Mayer United States, department of agriculture human nutrition research center on aging, Tufts university, IOF, Boston, MA, USA
^cg NIHR Southampton biomedical research centre, university of Southampton, university hospital Southampton, ESCEO/IOF, Southampton, United Kingdom
^ch Department of rheumatology, Saint-Luc university hospital, université catholique de Louvain, ESCEO/IOF, Brussels, Belgium
^ci Department of rheumatology, hôpital Nord, Inserm U1088, GRIO, Amiens, France
^cj Department of orthopaedic and trauma surgery, Saint-Antoine hospital, UPMC-Sorbonne universités, GRIO, Paris, France
^ck Department of internal medicine, hospital del Mar, bone and joint research unit, Municipal institute of medical research, ESCEO/IOF, Barcelona, Spain
^cl Centre for muscle and bone research, charité universitätsmedizin Berlin, ESCEO/IOF, Hindenburgdamm 30, 12203 Berlin, Germany
^cm Universitatsklinikum Schleswig-Holstein, ESCEO/IOF, Kiel, Germany
^cn MRC lifecourse epidemiology unit, university of Southampton, ESCEO/IOF, SO16 6YD Southampton, United Kingdom
^co Department of health services research, school for public health and primary care (CAPHRI), Maastricht university, ESCEO/IOF, Maastricht, The Netherlands
^cp NIHR musculoskeletal biomedical research unit, Nuffield department of orthopaedics, university of Oxford, ESCEO/IOF, Oxford, United Kingdom
^cq Research center for ageing and osteoporosis, department of clinical biochemistry, Copenhagen university hospital, Rigshospitalet, Glostrup, Denmark
^cr Institute of clinical medicine, faculty of health sciences, university of Copenhagen, ESCEO/IOF, Copenhagen, Denmark
^cs University of British Columbia, IOF, Vancouver, Canada
^ct University hospital Basel, Petersgraben, ESCEO/IOF, Basel, Switzerland
^cu Centre de rhumatologie, CHU Purpan, GRIO, Toulouse, France
^cv Service de rhumatologie, CHU d’Angers, GRIO, Angers, France
^cw College of medicine, university of Manitoba, Winnipeg, IOF, Manitoba, Canada
^cx Service de rhumatologie, CHR d’Orléans, GRIO, La Source, France
^cy New Mexico clinical research and osteoporosis center, IOF, Albuquerque, NM, USA
^cz National center for global health and medicine, IOF, 162-8655 Tokyo, Japan
^da Department of medicine, McMaster university, IOF, Hamilton, ON, Canada
^db Department of rheumatology, Cochin hospital, and epidemiology and biostatistics unit, Sorbonne Paris Cité research center, Paris Descartes university, Inserm U1153, ESCEO/GRIO/IOF, Paris, France
^dc Cedars-Sinai medical center, IOF, 8700, Beverly Boulevard, 90048 Los Angeles, CA, USA
^dd Research group into osteoporosis and mineral metabolism, university of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
^de Bone metabolism unit, internal medicine service, university insular hospital, ESCEO/IOF, Las Palmas de Gran Canaria, Spain
^df Hôpital de Bellevue, groupe de recherche et d’information sur les osteoporoses, ESCEO/GRIO//IOF, Saint-Étienne, France
^dg School of pathology and laboratory medicine, university of Western Australia, IOF, 6009 Nedlands, WA, Australia
^dh Mercy health osteoporosis and bone health services clinical trial center, IOF, Cincinnati, Ohio, USA
^di CHU de Nancy, service d’endocrinologie, GRIO, 54500 Vandœuvre-lès-Nancy, France

^a Department of internal medicine and geriatrics, Montpellier university hospital, EA 2991 movement to health, Euromov, Montpellier university, MacVia-LR, EIP-AHA reference site, EUGMS, Montpellier, France
^b Department of geriatric medicine, Nottingham university hospitals NHS Trust Nottingham, EUMS, Nottingham, United Kingdom
^c Inserm, U1153, Orchard Team, centre of research in epidemiology and statistics, Sorbonne Paris Cité (CRESS), Paris Descartes university, EUGMS, Paris, France
^d Department of ageing and health, Guy's and Saint-Thomas’ NHS Trust, EUGMS, London, United Kingdom
^e Umeå university, department of community medicine and rehabilitation, physiotherapy, EUGMS, Umeå, Sweden
^f Geriatrics department Academisch Medisch Centrum gériatrie, EUGMS, Amsterdam, The Netherlands
^g MacVia-LR, EIP-AHA reference Site, Respiratory diseases department, Montpellier university hospital, Inserm U1018, Villejuif, France
^h Department of geriatrics, EUGMS, university hospital of Nancy, Inserm, U1116, CIC-P 1433, université de Lorraine, Lorraine, France
ⁱ MRC lifecourse epidemiology unit, university of Southampton, Southampton, United Kingdom
^j NIHR musculoskeletal biomedical research unit, ESCEO/IOF, university of Oxford, Oxford, United Kingdom
^k WHO collaborative centre for metabolic bone diseases, ESCEO/IOF, university of Sheffield medical school, Beech Hill road, S10 2RX Sheffield, United Kingdom
^l Department of public health, epidemiology and health economics, ESCEO/IOF, university of Liege, CHU Sart Tilman B23, 4000 Liège, Belgium
^m Service of bone diseases, ESCEO/IOF, Geneva university hospitals, faculty of medicine, Geneva, Switzerland
ⁿ Hôpital Roger-Salengro, osteoporosis research and information group (GRIO), Lille, France
^o Geriatric unit, National clinical section of IAGG-ER, university of Palermo, Palermo, Italy
^p Department for muskuloskeletal rehabilitation, prevention and health service research center for sport science and sport medicine (CSSB), center for musculoskeletal sugery (CMSC) Charité, universitätsmedizin Berlin, Berlin, Germany
^q Department of orthopedics and traumatology, fragility fracture network, Medical Park of Berlin, Berlin, Germany
^r Gérontopôle, IAGG-ER, institute of ageing, university hospital of Toulouse, Toulouse, France
^s National research council, EUGMS, aging branch, institute of neuroscience, Padova, Italy
^t University of Helsinki, Helsinki university central hospital, Helsinki, Finland
^u University of Oulu, EUGMS, center for life course health research, Oulu, Finland

^⁎Corresponding author. Pôle de gériatrie, centre Antonin-Balmes, CHU de Montpellier, 39, avenue Charles-Flahault, 3439 Montpellier cedex 5, France. Tel.: +33 4 67 33 99 57.

Abstract

Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest group on falls and fracture prevention of the European union geriatric medicine society (EUGMS), in collaboration with the International association of gerontology and geriatrics for the European region (IAGG-ER), the European union of medical specialists (EUMS), the Fragility fracture network (FFN), the International osteoporosis foundation (IOF) – European society for clinical and economic aspects of osteoporosis and osteoarthritis (ECCEO), outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people.

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Keywords : Falls, Fragility fracture, Older people, Prevention, Position statement