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104. EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures

Author

Lems, W. F., Lems, W. F., Dreinhofer, K. E., Bischoff-Ferrari, H., Blauth, M., Czerwinski, E., da Silva, J. A. P., Herrera, A., Hoffmeyer, P., Kvien, T., Maalouf, G., Marsh, D., Puget, J., Puhl, W., Poor, G., Rasch, L., Roux, C., Schuler, S., Seriolo, B., Tarantino, U., van Geel, T., Woolf, A., Wyers, C., Geusens, P., Lems, W. F., Lems, W. F., Dreinhofer, K. E., Bischoff-Ferrari, H., Blauth, M., Czerwinski, E., da Silva, J. A. P., Herrera, A., Hoffmeyer, P., Kvien, T., Maalouf, G., Marsh, D., Puget, J., Puhl, W., Poor, G., Rasch, L., Roux, C., Schuler, S., Seriolo, B., Tarantino, U., van Geel, T., Woolf, A., Wyers, C., and Geusens, P.

Abstract

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.

Published
2017

118. Clinical and Radiographic Outcomes of Four Different Treatment Strategies in Patients With Early Rheumatoid Arthritis (the BeSt Study): A Randomized, Controlled Trial

Author

Goekoop-Ruiterman, Y. P. M., de Vries-Bouwstra, J. K., Allaart, C. F., van Zeben, D., Kerstens, P. J. S. M., Hazes, J. M. W., Zwinderman, A. H., Ronday, H. K., Han, K. H., Wesledt, M. L., Gerards, A. H., van Groenendael, J. H. L. M., Lems, W. F., van Krugten, M. V., Breedveld, F. C., and Dijkmans, B. A. C.

Published
2008

128. Clinical and Radiographic Outcomes of Four Different Treatment Strategies in Patients With Early Rheumatoid Arthritis (the BeSt Study): A Randomized, Controlled Trial

Author

Goekoop-Ruiterman, Y. P. M., De Vries-Bouwstra, J. K., Allaart, C. F., Van Zeben, D., Kerstens, P. J. S. M., Hazes, J. M. W., Zwinderman, A. H., Ronday, H. K., Han, K. H., Westedt, M. L., Gerards, A. H., Van Groenendael, J. H. L. M., Lems, W. F., Van Krugten, M. V., Breedveld, F. C., and Dijkmans, B. A. C.

Published
2005

132. De Heup

Author

Lems, W. F., primary and Bierma-Zeinstra, S. M. A., additional

Published
2000
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133. Two-year persistence with teriparatide improved significantly after introduction of an educational and motivational support program

Author

van Maren, M A, Wyers, C E, Driessen, J H M, Visser, J V, de Vries, F, van de Wijdeven, K, Gevers, S, Lems, W F, Emmelot-Vonk, M H, van den Bergh, J P W, van Maren, M A, Wyers, C E, Driessen, J H M, Visser, J V, de Vries, F, van de Wijdeven, K, Gevers, S, Lems, W F, Emmelot-Vonk, M H, and van den Bergh, J P W

Abstract

This study evaluated the 2-year persistence with teriparatide in the Netherlands. Analyses showed that the risk of non-persistence was 28% lower in patients who were followed according to an additional educational and motivational support program.INTRODUCTION: Until recently, teriparatide (TPTD) was a third-line treatment option for severe osteoporosis in the Netherlands, which could only be prescribed by medical specialists based on a specific medical statement. We aimed to determine whether an educational and motivational support program (EMSP) increased 2-year treatment persistence with TPTD in patients with severe osteoporosis.METHODS: We evaluated persistence in 1573 Dutch patients treated with TPTD from January 2013 until January 2018. From January 2013 onwards, all patients received a basic support program (BSP) consisting of an educational home visit to initiate TPTD treatment and phone calls (at 1, 2.5 and 8 weeks). Since May 2015, all patients received the EMSP consisting of the BSP extended with evaluation of medication adherence during phone calls, an additional phone call (at 12 months), and motivational letters at 9 and 14 months.RESULTS: The EMSP showed a statistically significantly higher 2-year persistence (78%) with TPTD as compared with the BSP (72%). Reasons for treatment discontinuation were comparable between groups, except for the proportion of patients who had stopped TPTD administration due to side effects, which was significantly lower in the EMSP group (8% vs. 15% in BSP, p < 0.001). Overall, the risk of non-persistence was 28% lower in the EMSP compared with the BSP group (HR: 0.72; 95% CI: 0.55-0.93).CONCLUSION: The introduction of the EMSP has demonstrated to improve the persistence with TPTD, resulting in 78% of the patients being persistent with TPTD during the 2-year treatment period.

Published
2019

134. Secondary fracture prevention: Drug treatment, fall prevention and nutrition requirements

Author

Geusens, P., Geusens, P., Lems, W. F., Bours, S., Bergh, J. P. Vd, Geusens, P., Geusens, P., Lems, W. F., Bours, S., and Bergh, J. P. Vd

Abstract

In view of the high imminent risk for subsequent fractures, evaluation as early as possible after the fracture will result in early decisions about drug treatment, fall prevention and nutritional supplements.Drug treatment includes anti-resorptive and bone forming agents. Anti-resorptive therapy with broad spectrum fracture prevention and early anti-fracture effects are the first choice. In patients with multiple or severe VFs, the bone forming agent teriparatide should be considered.Adequate calcium and vitamin D are needed in all patients, together with appropriate nutrition, including adequate protein intake. (C) 2019 Elsevier Ltd. All rights reserved.

Published
2019

135. Two-year persistence with teriparatide improved significantly after introduction of an educational and motivational support program

Author

Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology, van Maren, M A, Wyers, C E, Driessen, J H M, Visser, J V, de Vries, F, van de Wijdeven, K, Gevers, S, Lems, W F, Emmelot-Vonk, M H, van den Bergh, J P W, Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology, van Maren, M A, Wyers, C E, Driessen, J H M, Visser, J V, de Vries, F, van de Wijdeven, K, Gevers, S, Lems, W F, Emmelot-Vonk, M H, and van den Bergh, J P W

Published
2019

136. Two-year persistence with teriparatide improved significantly after introduction of an educational and motivational support program

Author

MS Geriatrie, Circulatory Health, van Maren, M A, Wyers, C E, Driessen, J H M, Visser, J V, de Vries, F, van de Wijdeven, K, Gevers, S, Lems, W F, Emmelot-Vonk, M H, van den Bergh, J P W, MS Geriatrie, Circulatory Health, van Maren, M A, Wyers, C E, Driessen, J H M, Visser, J V, de Vries, F, van de Wijdeven, K, Gevers, S, Lems, W F, Emmelot-Vonk, M H, and van den Bergh, J P W

Published
2019

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