Multidisciplinary expert consensus on secondary fracture prevention in Spain

Area of Science:

• Geriatrics
• Rheumatology
• Primary Care Medicine
• Public Health

Background:

• Secondary fracture prevention is crucial for reducing morbidity and mortality in osteoporotic patients.
• Current patient management strategies in Spain present gaps that hinder effective secondary fracture prevention.
• Optimizing care requires a multidisciplinary approach and expert consensus on best practices.

Purpose of the Study:

• To establish a Spanish multidisciplinary expert consensus on secondary fracture prevention.
• Identify key areas for improvement in current secondary fracture prevention protocols.
• Assess the feasibility and desirability of implementing new strategies.

Main Methods:

• A two-round Delphi consensus study was conducted with 102 invited experts from 14 scientific societies.
• A 43-item questionnaire, developed from literature review and expert discussion, assessed current practices, desired changes, and implementation prognosis.
• Consensus was defined as ≥75% agreement or disagreement; 75 experts responded to the first round and 69 to the second.

Main Results:

• Consensus was achieved for 79.1% of items, with 100% agreement on desired improvements but only 58.1% on implementation prognosis.
• Key areas needing improvement include clinical report standardization, hospital-primary care communication, use of health-related quality of life (HRQoL) questionnaires, and treatment compliance monitoring.
• Specific strategies like effective communication via case managers and telephone/mail showed low prognosis agreement (47.8%).

Conclusions:

• Health professionals agree on the need to enhance secondary fracture prevention strategies.
• Significant barriers to the application of some consensus-driven strategies were identified.
• Future efforts should prioritize strategies with low current application and high divergence between desired implementation and perceived feasibility.