How to implement guidelines and models of care

Best Practice & Research Clinical Rheumatology, vol. 36, pp. 101759

Abstract

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.

Authors 6

1. Piet Geusens corresponding

   Maastricht University

   Affiliation as printed

   Department of Rheumatology, Maastricht University, Minderbroedersberg 4-6, 6211 LK Maastricht, Netherlands. Electronic address: Piet.geusens@scarlet.be

   Department of Rheumatology, Maastricht University, Minderbroedersberg 4-6, 6211 LK Maastricht, Netherlands

2. Natasha M. Appelman‐Dijkstra Aachen Department of Internal Medicine/Endocrinology

   Leiden University Medical Center

   Affiliation as printed

   Department of Internal Medicine-Endocrinology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands. Electronic address: n.m.appelman-dijkstra@lumc.nl

   Department of Internal Medicine-Endocrinology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands

3. M. Carola Zillikens

   Erasmus MC · Erasmus University Rotterdam

   Affiliation as printed

   Department of Internal Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands. Electronic address: m.c.zillikens@erasmusmc.nl

   Department of Internal Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands

4. Hanna C. Willems

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Geriatrics, Amsterdam University Medical Center, De Boelelaan 1117 1081 HV Amsterdam, Netherlands. Electronic address: h.c.willems@amc.nl

   Department of Geriatrics, Amsterdam University Medical Center, De Boelelaan 1117 1081 HV Amsterdam, Netherlands

5. Willem F. Lems

   Amsterdam University Medical Centers

   Affiliation as printed

   Department of Rheumatology, Amsterdam University Medical Center, De Boelelaan 1117 1081 HV Amsterdam, Netherlands. Electronic address: wf.lems@amsterdamumc.nl

   Department of Rheumatology, Amsterdam University Medical Center, De Boelelaan 1117 1081 HV Amsterdam, Netherlands

6. Joop P. van den Bergh

   VieCuri Medisch Centrum

   Affiliation as printed

   Department of Internal Medicine, VieCuri Medisch Cenrum, Tegelseweg 210, 5912 BL Venlo, Netherlands. Electronic address: jvdbergh@viecuri.nl

   Department of Internal Medicine, VieCuri Medisch Cenrum, Tegelseweg 210, 5912 BL Venlo, Netherlands