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. 2021 Feb 27;16(1):48.
doi: 10.1007/s11657-021-00878-w.

Multidisciplinary expert consensus on secondary fracture prevention in Spain

E Casado  1 , J Blanch  2 , C Carbonell  3   4 , J C Bastida  5   6 , J L Pérez-Castrillón  7 , L Canals  8 , L Lizán  9   10
Affiliations

Multidisciplinary expert consensus on secondary fracture prevention in Spain

E Casado et al. Arch Osteoporos. .

Abstract

The study aimed to achieve expert consensus to optimize secondary fracture prevention in Spain. Relevant gaps in current patient management were identified. However, some aspects were considered difficult to apply. Future efforts should focus on those items with greatest divergences between importance and feasibility.

Purpose: To establish a Spanish multidisciplinary expert consensus on secondary fracture prevention.

Methods: A two-round Delphi consensus was conducted, guided by a Scientific Committee. The 43-item study questionnaire was designed from a literature review and a subsequent multidisciplinary expert group (n = 12) discussion. The first-round questionnaire, using a 7-point Likert scale, assessed the experts' opinion of the current situation, their wish for items to happen, and their prognosis that items would be implemented within 5 years. Items for which consensus was not achieved were included in the second round. Consensus was defined as ≥ 75% agreement or ≥ 75% disagreement. A total of 102 experts from 14 scientific societies were invited to participate.

Results: A total of 75 (response rate 73.5%) and 69 (92.0%) experts answered the first and second Delphi rounds, respectively. Participants mean age was 51.8 years [standard deviation (SD): 10.1 years]; being 24.0% rheumatologists, 21.3% primary care physicians, 14.7% geriatricians, 8.0% internal medicine specialists, 8.0% rehabilitation physicians, and 8.0% gynecologists. Consensus was achieved for 79.1% of items (wish, 100%; prognosis, 58.1%). Effective secondary prevention strategies identified as requiring improvement included: clinical report standardization, effective hospital primary care communication (telephone/mail and case managers), health-related quality of life (HRQoL) questionnaires use, and treatment compliance monitoring (prognosis agreement 33.3%, 47.8%, 18.8%, and 55.1%, respectively).

Conclusion: A consensus was reached by health professionals in their wish to implement strategies to optimize secondary fracture prevention; however, they considered some difficult to apply. Efforts should focus on those items with currently low application and those with greatest divergence between wish and prognosis.

Keywords: Consensus; Delphi; Fracture; Fragility; Osteoporosis; Secondary prevention.

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Conflict of interest statement

Blanch J has received consulting fees from: Amgen, Lilly, Lacer Farma, and gebro Pharma. Pérez-Castrillón JL has ownership or partnership of Farmalider and has received consulting fees from: Amgen, Lilly, MSD and FAES. Carbonell C has received consulting fees from Amgen and Rubió. Bastida JC has received fees as a speaker or remuneration for attendance to Congresses from: Almirall, Amgen, Boehringer, Bayer, Esteve, Grunenthal, GSK, FAES, Ferrer, MSD, Pfizer, Rovi and Recordati. Lizán L has received consulting fees from Novartis, Bristol Myers Squibb, Sanofi, Boehringer Ingelheim, Nestle Health Science, Celgene, Gilead and Merck; and has participated in speaker bureaus for Lilly, IESE, EADA and Roche. Casado E has received fees for lectures and/or participation in advisory boards from Amgen, Lilly, UCB, Rubió and Theramex. Canals L works at Amgen and hold stock in Amgen.

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