Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021

Giovanni Corrao; Annalisa Biffi; Gloria Porcu; Raffaella Ronco; Giovanni Adami; Rosaria Alvaro; Riccardo Bogini; Achille Patrizio Caputi; Luisella Cianferotti; Bruno Frediani; Davide Gatti; Stefano Gonnelli; Giovanni Iolascon; Andrea Lenzi; Salvatore Leone; Raffaella Michieli; Silvia Migliaccio; Tiziana Nicoletti; Marco Paoletta; Annalisa Pennini; Eleonora Piccirilli; Maurizio Rossini; Umberto Tarantino; Maria Luisa Brandi

doi:10.3389/fendo.2023.1137671

Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021

Front Endocrinol (Lausanne). 2023 Apr 18:14:1137671. doi: 10.3389/fendo.2023.1137671. eCollection 2023.

Authors

Giovanni Corrao^{1

2}, Annalisa Biffi^{1

2}, Gloria Porcu^{1

2}, Raffaella Ronco^{1

2}, Giovanni Adami³, Rosaria Alvaro⁴, Riccardo Bogini⁵, Achille Patrizio Caputi⁶, Luisella Cianferotti⁷, Bruno Frediani⁸, Davide Gatti³, Stefano Gonnelli⁹, Giovanni Iolascon¹⁰, Andrea Lenzi¹¹, Salvatore Leone¹², Raffaella Michieli¹³, Silvia Migliaccio¹⁴, Tiziana Nicoletti¹⁵, Marco Paoletta¹⁰, Annalisa Pennini⁴, Eleonora Piccirilli^{16

17}, Maurizio Rossini³, Umberto Tarantino^{16

17}, Maria Luisa Brandi⁷

Affiliations

¹ National Centre for Healthcare Research and Pharmacoepidemiology, Laboratory of the University of Milano-Bicocca, Milan, Italy.
² Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy.
³ Rheumatology Unit, University of Verona, Verona, Italy.
⁴ Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
⁵ Local Health Unit (USL) Umbria, Perugia, Italy.
⁶ Department of Pharmacology, School of Medicine, University of Messina, Messina, Italy.
⁷ Italian Bone Disease Research Foundation, Fondazione Italiana Ricerca sulle Malattie dell'Osso (FIRMO), Florence, Italy.
⁸ Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.
⁹ Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy.
¹⁰ Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy.
¹¹ Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy.
¹² AMICI Onlus, Associazione Nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy.
¹³ Italian Society of General Medicine and Primary Care Società Italiana di Medicina Generale e delle cure primarie (SIMG), Florence, Italy.
¹⁴ Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy.
¹⁵ CnAMC, Coordinamento nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy.
¹⁶ Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy.
¹⁷ Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy.

Abstract

Background: Fragility fractures are a major public health concern owing to their worrying and growing burden and their onerous burden upon health systems. There is now a substantial body of evidence that individuals who have already suffered a fragility fracture are at a greater risk for further fractures, thus suggesting the potential for secondary prevention in this field.

Purpose: This guideline aims to provide evidence-based recommendations for recognizing, stratifying the risk, treating, and managing patients with fragility fracture. This is a summary version of the full Italian guideline.

Methods: The Italian Fragility Fracture Team appointed by the Italian National Health Institute was employed from January 2020 to February 2021 to (i) identify previously published systematic reviews and guidelines on the field, (ii) formulate relevant clinical questions, (iii) systematically review literature and summarize evidence, (iv) draft the Evidence to Decision Framework, and (v) formulate recommendations.

Results: Overall, 351 original papers were included in our systematic review to answer six clinical questions. Recommendations were categorized into issues concerning (i) frailty recognition as the cause of bone fracture, (ii) (re)fracture risk assessment, for prioritizing interventions, and (iii) treatment and management of patients experiencing fragility fractures. Six recommendations were overall developed, of which one, four, and one were of high, moderate, and low quality, respectively.

Conclusions: The current guidelines provide guidance to support individualized management of patients experiencing non-traumatic bone fracture to benefit from secondary prevention of (re)fracture. Although our recommendations are based on the best available evidence, questionable quality evidence is still available for some relevant clinical questions, so future research has the potential to reduce uncertainty about the effects of intervention and the reasons for doing so at a reasonable cost.

Keywords: evidence-based guideline; fragility fracture; grade; secondary prevention; systematic review.

Copyright © 2023 Corrao, Biffi, Porcu, Ronco, Adami, Alvaro, Bogini, Caputi, Cianferotti, Frediani, Gatti, Gonnelli, Iolascon, Lenzi, Leone, Michieli, Migliaccio, Nicoletti, Paoletta, Pennini, Piccirilli, Rossini, Tarantino and Brandi.

Publication types

Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Continuity of Patient Care
Humans
Osteoporotic Fractures* / diagnosis
Osteoporotic Fractures* / epidemiology
Osteoporotic Fractures* / etiology
Risk Assessment
Secondary Prevention

Grants and funding

This study received funding from ALTIS Omnia Pharma Service. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.