Osteoporosis International

, Volume 27, Issue 7, pp 2197–2206 | Cite as

Fracture healing: a consensus report from the International Osteoporosis Foundation Fracture Working Group

  • S. L. SilvermanEmail author
  • E. S. Kupperman
  • S. V. Bukata
  • Members of IOF Fracture Working Group
Original Article



We used the RAND UCLA appropriateness method to decide appropriateness of use of osteoporosis medication after incident fracture and potential for fracture healing and make suggestions for trial design for clinical and preclinical research.


To develop appropriateness criteria to assist in the use and study of osteoporosis medications in patients with recent fracture and in the potential use of osteoporosis medications to enhance delayed fracture healing. To promote further research by suggesting preclinical and clinical trial design for studies where fracture healing is the endpoint.


Design: RAND/UCLA appropriateness method (RUAM). Participants: A panel of experts, both members and non-members of the International Osteoporosis Foundation Fracture Working Group, were identified consisting of geriatricians, rheumatologists, orthopedists, endocrinologists, and internists. This resulted in a round 1 panel of 15 panelists, round 2 panel of 15 members, and a round 3 panel of 14 members. Main outcome measure: Agreement on statements and scenarios using RUAM. Three rounds of voting by panelists took place. Agreement in a third round was reached for 111 statements and scenarios, measured by median panel ratings and the amount of dispersion of panel ratings, based on the interpercentile range.


An expert panel validated a set of statements and scenarios about the use of osteoporosis medications after incident fracture and use of these medications to enhance delayed fracture healing and made recommendations for study designs to investigate the effect of osteoporosis medications on fracture healing.


The result of this exercise is intended to assist in improving patient care by identifying the appropriateness of use of osteoporosis medications after fracture and in fracture healing and to make suggestions for further preclinical and clinical research.


Fracture healing Osteoporotic fracture Trial design 


Conflicts of interest

Stuart Silverman is a consultant for Amgen, Alexion, Eli Lilly, and Pfizer. He is a member of the Speakers Bureau for Lilly and Pfizer. He has received research grants from Pfizer, Lilly, and Amgen. Susan V. Bukata is a consultant for Amgen and Eli Lilly and a member of the Speakers Bureau for Eli Lilly, Amgen, and Novartis. Eli Kupperman has no disclosures.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  • S. L. Silverman
    • 1
    • 2
    Email author
  • E. S. Kupperman
    • 3
  • S. V. Bukata
    • 3
  • Members of IOF Fracture Working Group
  1. 1.Cedars-Sinai Medical CenterLos AngelesUSA
  2. 2.David Geffen School of MedicineUCLALos AngelesUSA
  3. 3.UCLA Department of OrthopedicsSanta MonicaUSA

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