Screening to prevent fragility fractures among adults 40 years and older in primary care: protocol for a systematic review
Abstract Purpose To inform recommendations by the Canadian Task Force on Preventive Health Care by systematically reviewing direct evidence on the effectiveness and acceptability of screening adults 40 years and older in primary care to reduce fragility fractures and related mortality and morbidity,...
Ausführliche Beschreibung
Autor*in: |
Michelle Gates [verfasserIn] Jennifer Pillay [verfasserIn] Guylène Thériault [verfasserIn] Heather Limburg [verfasserIn] Roland Grad [verfasserIn] Scott Klarenbach [verfasserIn] Christina Korownyk [verfasserIn] Donna Reynolds [verfasserIn] John J. Riva [verfasserIn] Brett D. Thombs [verfasserIn] Gregory A. Kline [verfasserIn] William D. Leslie [verfasserIn] Susan Courage [verfasserIn] Ben Vandermeer [verfasserIn] Robin Featherstone [verfasserIn] Lisa Hartling [verfasserIn] |
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E-Artikel |
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Sprache: |
Englisch |
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2019 |
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Übergeordnetes Werk: |
In: Systematic Reviews - BMC, 2012, 8(2019), 1, Seite 21 |
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Übergeordnetes Werk: |
volume:8 ; year:2019 ; number:1 ; pages:21 |
Links: |
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DOI / URN: |
10.1186/s13643-019-1094-5 |
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Katalog-ID: |
DOAJ058613048 |
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520 | |a Abstract Purpose To inform recommendations by the Canadian Task Force on Preventive Health Care by systematically reviewing direct evidence on the effectiveness and acceptability of screening adults 40 years and older in primary care to reduce fragility fractures and related mortality and morbidity, and indirect evidence on the accuracy of fracture risk prediction tools. Evidence on the benefits and harms of pharmacological treatment will be reviewed, if needed to meaningfully influence the Task Force’s decision-making. Methods A modified update of an existing systematic review will evaluate screening effectiveness, the accuracy of screening tools, and treatment benefits. For treatment harms, we will integrate studies from existing systematic reviews. A de novo review on acceptability will be conducted. Peer-reviewed searches (Medline, Embase, Cochrane Library, PsycINFO [acceptability only]), grey literature, and hand searches of reviews and included studies will update the literature. Based on pre-specified criteria, we will screen studies for inclusion following a liberal-accelerated approach. Final inclusion will be based on consensus. Data extraction for study results will be performed independently by two reviewers while other data will be verified by a second reviewer; there may be some reliance on extracted data from the existing reviews. The risk of bias assessments reported in the existing reviews will be verified and for new studies will be performed independently. When appropriate, results will be pooled using either pairwise random effects meta-analysis (screening and treatment) or restricted maximum likelihood estimation with Hartun-Knapp-Sidnick-Jonkman correction (risk prediction model calibration). Subgroups of interest to explain heterogeneity are age, sex, and menopausal status. Two independent reviewers will rate the certainty of evidence using the GRADE approach, with consensus reached for each outcome rated as critical or important by the Task Force. Discussion Since the publication of other guidance in Canada, new trials have been published that are likely to improve understanding of screening in primary care settings to prevent fragility fractures. A systematic review is required to inform updated recommendations that align with the current evidence base. | ||
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10.1186/s13643-019-1094-5 doi (DE-627)DOAJ058613048 (DE-599)DOAJ79ced8b8de8743b28f948b0ac2250467 DE-627 ger DE-627 rakwb eng Michelle Gates verfasserin aut Screening to prevent fragility fractures among adults 40 years and older in primary care: protocol for a systematic review 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Purpose To inform recommendations by the Canadian Task Force on Preventive Health Care by systematically reviewing direct evidence on the effectiveness and acceptability of screening adults 40 years and older in primary care to reduce fragility fractures and related mortality and morbidity, and indirect evidence on the accuracy of fracture risk prediction tools. Evidence on the benefits and harms of pharmacological treatment will be reviewed, if needed to meaningfully influence the Task Force’s decision-making. Methods A modified update of an existing systematic review will evaluate screening effectiveness, the accuracy of screening tools, and treatment benefits. For treatment harms, we will integrate studies from existing systematic reviews. A de novo review on acceptability will be conducted. Peer-reviewed searches (Medline, Embase, Cochrane Library, PsycINFO [acceptability only]), grey literature, and hand searches of reviews and included studies will update the literature. Based on pre-specified criteria, we will screen studies for inclusion following a liberal-accelerated approach. Final inclusion will be based on consensus. Data extraction for study results will be performed independently by two reviewers while other data will be verified by a second reviewer; there may be some reliance on extracted data from the existing reviews. The risk of bias assessments reported in the existing reviews will be verified and for new studies will be performed independently. When appropriate, results will be pooled using either pairwise random effects meta-analysis (screening and treatment) or restricted maximum likelihood estimation with Hartun-Knapp-Sidnick-Jonkman correction (risk prediction model calibration). Subgroups of interest to explain heterogeneity are age, sex, and menopausal status. Two independent reviewers will rate the certainty of evidence using the GRADE approach, with consensus reached for each outcome rated as critical or important by the Task Force. Discussion Since the publication of other guidance in Canada, new trials have been published that are likely to improve understanding of screening in primary care settings to prevent fragility fractures. A systematic review is required to inform updated recommendations that align with the current evidence base. Systematic review Guideline Fragility fractures Screening Medicine R Jennifer Pillay verfasserin aut Guylène Thériault verfasserin aut Heather Limburg verfasserin aut Roland Grad verfasserin aut Scott Klarenbach verfasserin aut Christina Korownyk verfasserin aut Donna Reynolds verfasserin aut John J. Riva verfasserin aut Brett D. Thombs verfasserin aut Gregory A. Kline verfasserin aut William D. Leslie verfasserin aut Susan Courage verfasserin aut Ben Vandermeer verfasserin aut Robin Featherstone verfasserin aut Lisa Hartling verfasserin aut In Systematic Reviews BMC, 2012 8(2019), 1, Seite 21 (DE-627)718627210 (DE-600)2662257-9 20464053 nnns volume:8 year:2019 number:1 pages:21 https://doi.org/10.1186/s13643-019-1094-5 kostenfrei https://doaj.org/article/79ced8b8de8743b28f948b0ac2250467 kostenfrei http://link.springer.com/article/10.1186/s13643-019-1094-5 kostenfrei https://doaj.org/toc/2046-4053 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 8 2019 1 21 |
spelling |
10.1186/s13643-019-1094-5 doi (DE-627)DOAJ058613048 (DE-599)DOAJ79ced8b8de8743b28f948b0ac2250467 DE-627 ger DE-627 rakwb eng Michelle Gates verfasserin aut Screening to prevent fragility fractures among adults 40 years and older in primary care: protocol for a systematic review 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Purpose To inform recommendations by the Canadian Task Force on Preventive Health Care by systematically reviewing direct evidence on the effectiveness and acceptability of screening adults 40 years and older in primary care to reduce fragility fractures and related mortality and morbidity, and indirect evidence on the accuracy of fracture risk prediction tools. Evidence on the benefits and harms of pharmacological treatment will be reviewed, if needed to meaningfully influence the Task Force’s decision-making. Methods A modified update of an existing systematic review will evaluate screening effectiveness, the accuracy of screening tools, and treatment benefits. For treatment harms, we will integrate studies from existing systematic reviews. A de novo review on acceptability will be conducted. Peer-reviewed searches (Medline, Embase, Cochrane Library, PsycINFO [acceptability only]), grey literature, and hand searches of reviews and included studies will update the literature. Based on pre-specified criteria, we will screen studies for inclusion following a liberal-accelerated approach. Final inclusion will be based on consensus. Data extraction for study results will be performed independently by two reviewers while other data will be verified by a second reviewer; there may be some reliance on extracted data from the existing reviews. The risk of bias assessments reported in the existing reviews will be verified and for new studies will be performed independently. When appropriate, results will be pooled using either pairwise random effects meta-analysis (screening and treatment) or restricted maximum likelihood estimation with Hartun-Knapp-Sidnick-Jonkman correction (risk prediction model calibration). Subgroups of interest to explain heterogeneity are age, sex, and menopausal status. Two independent reviewers will rate the certainty of evidence using the GRADE approach, with consensus reached for each outcome rated as critical or important by the Task Force. Discussion Since the publication of other guidance in Canada, new trials have been published that are likely to improve understanding of screening in primary care settings to prevent fragility fractures. A systematic review is required to inform updated recommendations that align with the current evidence base. Systematic review Guideline Fragility fractures Screening Medicine R Jennifer Pillay verfasserin aut Guylène Thériault verfasserin aut Heather Limburg verfasserin aut Roland Grad verfasserin aut Scott Klarenbach verfasserin aut Christina Korownyk verfasserin aut Donna Reynolds verfasserin aut John J. Riva verfasserin aut Brett D. Thombs verfasserin aut Gregory A. Kline verfasserin aut William D. Leslie verfasserin aut Susan Courage verfasserin aut Ben Vandermeer verfasserin aut Robin Featherstone verfasserin aut Lisa Hartling verfasserin aut In Systematic Reviews BMC, 2012 8(2019), 1, Seite 21 (DE-627)718627210 (DE-600)2662257-9 20464053 nnns volume:8 year:2019 number:1 pages:21 https://doi.org/10.1186/s13643-019-1094-5 kostenfrei https://doaj.org/article/79ced8b8de8743b28f948b0ac2250467 kostenfrei http://link.springer.com/article/10.1186/s13643-019-1094-5 kostenfrei https://doaj.org/toc/2046-4053 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 8 2019 1 21 |
allfields_unstemmed |
10.1186/s13643-019-1094-5 doi (DE-627)DOAJ058613048 (DE-599)DOAJ79ced8b8de8743b28f948b0ac2250467 DE-627 ger DE-627 rakwb eng Michelle Gates verfasserin aut Screening to prevent fragility fractures among adults 40 years and older in primary care: protocol for a systematic review 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Purpose To inform recommendations by the Canadian Task Force on Preventive Health Care by systematically reviewing direct evidence on the effectiveness and acceptability of screening adults 40 years and older in primary care to reduce fragility fractures and related mortality and morbidity, and indirect evidence on the accuracy of fracture risk prediction tools. Evidence on the benefits and harms of pharmacological treatment will be reviewed, if needed to meaningfully influence the Task Force’s decision-making. Methods A modified update of an existing systematic review will evaluate screening effectiveness, the accuracy of screening tools, and treatment benefits. For treatment harms, we will integrate studies from existing systematic reviews. A de novo review on acceptability will be conducted. Peer-reviewed searches (Medline, Embase, Cochrane Library, PsycINFO [acceptability only]), grey literature, and hand searches of reviews and included studies will update the literature. Based on pre-specified criteria, we will screen studies for inclusion following a liberal-accelerated approach. Final inclusion will be based on consensus. Data extraction for study results will be performed independently by two reviewers while other data will be verified by a second reviewer; there may be some reliance on extracted data from the existing reviews. The risk of bias assessments reported in the existing reviews will be verified and for new studies will be performed independently. When appropriate, results will be pooled using either pairwise random effects meta-analysis (screening and treatment) or restricted maximum likelihood estimation with Hartun-Knapp-Sidnick-Jonkman correction (risk prediction model calibration). Subgroups of interest to explain heterogeneity are age, sex, and menopausal status. Two independent reviewers will rate the certainty of evidence using the GRADE approach, with consensus reached for each outcome rated as critical or important by the Task Force. Discussion Since the publication of other guidance in Canada, new trials have been published that are likely to improve understanding of screening in primary care settings to prevent fragility fractures. A systematic review is required to inform updated recommendations that align with the current evidence base. Systematic review Guideline Fragility fractures Screening Medicine R Jennifer Pillay verfasserin aut Guylène Thériault verfasserin aut Heather Limburg verfasserin aut Roland Grad verfasserin aut Scott Klarenbach verfasserin aut Christina Korownyk verfasserin aut Donna Reynolds verfasserin aut John J. Riva verfasserin aut Brett D. Thombs verfasserin aut Gregory A. Kline verfasserin aut William D. Leslie verfasserin aut Susan Courage verfasserin aut Ben Vandermeer verfasserin aut Robin Featherstone verfasserin aut Lisa Hartling verfasserin aut In Systematic Reviews BMC, 2012 8(2019), 1, Seite 21 (DE-627)718627210 (DE-600)2662257-9 20464053 nnns volume:8 year:2019 number:1 pages:21 https://doi.org/10.1186/s13643-019-1094-5 kostenfrei https://doaj.org/article/79ced8b8de8743b28f948b0ac2250467 kostenfrei http://link.springer.com/article/10.1186/s13643-019-1094-5 kostenfrei https://doaj.org/toc/2046-4053 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 8 2019 1 21 |
allfieldsGer |
10.1186/s13643-019-1094-5 doi (DE-627)DOAJ058613048 (DE-599)DOAJ79ced8b8de8743b28f948b0ac2250467 DE-627 ger DE-627 rakwb eng Michelle Gates verfasserin aut Screening to prevent fragility fractures among adults 40 years and older in primary care: protocol for a systematic review 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Purpose To inform recommendations by the Canadian Task Force on Preventive Health Care by systematically reviewing direct evidence on the effectiveness and acceptability of screening adults 40 years and older in primary care to reduce fragility fractures and related mortality and morbidity, and indirect evidence on the accuracy of fracture risk prediction tools. Evidence on the benefits and harms of pharmacological treatment will be reviewed, if needed to meaningfully influence the Task Force’s decision-making. Methods A modified update of an existing systematic review will evaluate screening effectiveness, the accuracy of screening tools, and treatment benefits. For treatment harms, we will integrate studies from existing systematic reviews. A de novo review on acceptability will be conducted. Peer-reviewed searches (Medline, Embase, Cochrane Library, PsycINFO [acceptability only]), grey literature, and hand searches of reviews and included studies will update the literature. Based on pre-specified criteria, we will screen studies for inclusion following a liberal-accelerated approach. Final inclusion will be based on consensus. Data extraction for study results will be performed independently by two reviewers while other data will be verified by a second reviewer; there may be some reliance on extracted data from the existing reviews. The risk of bias assessments reported in the existing reviews will be verified and for new studies will be performed independently. When appropriate, results will be pooled using either pairwise random effects meta-analysis (screening and treatment) or restricted maximum likelihood estimation with Hartun-Knapp-Sidnick-Jonkman correction (risk prediction model calibration). Subgroups of interest to explain heterogeneity are age, sex, and menopausal status. Two independent reviewers will rate the certainty of evidence using the GRADE approach, with consensus reached for each outcome rated as critical or important by the Task Force. Discussion Since the publication of other guidance in Canada, new trials have been published that are likely to improve understanding of screening in primary care settings to prevent fragility fractures. A systematic review is required to inform updated recommendations that align with the current evidence base. Systematic review Guideline Fragility fractures Screening Medicine R Jennifer Pillay verfasserin aut Guylène Thériault verfasserin aut Heather Limburg verfasserin aut Roland Grad verfasserin aut Scott Klarenbach verfasserin aut Christina Korownyk verfasserin aut Donna Reynolds verfasserin aut John J. Riva verfasserin aut Brett D. Thombs verfasserin aut Gregory A. Kline verfasserin aut William D. Leslie verfasserin aut Susan Courage verfasserin aut Ben Vandermeer verfasserin aut Robin Featherstone verfasserin aut Lisa Hartling verfasserin aut In Systematic Reviews BMC, 2012 8(2019), 1, Seite 21 (DE-627)718627210 (DE-600)2662257-9 20464053 nnns volume:8 year:2019 number:1 pages:21 https://doi.org/10.1186/s13643-019-1094-5 kostenfrei https://doaj.org/article/79ced8b8de8743b28f948b0ac2250467 kostenfrei http://link.springer.com/article/10.1186/s13643-019-1094-5 kostenfrei https://doaj.org/toc/2046-4053 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 8 2019 1 21 |
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Michelle Gates Jennifer Pillay Guylène Thériault Heather Limburg Roland Grad Scott Klarenbach Christina Korownyk Donna Reynolds John J. Riva Brett D. Thombs Gregory A. Kline William D. Leslie Susan Courage Ben Vandermeer Robin Featherstone Lisa Hartling |
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Michelle Gates |
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screening to prevent fragility fractures among adults 40 years and older in primary care: protocol for a systematic review |
title_auth |
Screening to prevent fragility fractures among adults 40 years and older in primary care: protocol for a systematic review |
abstract |
Abstract Purpose To inform recommendations by the Canadian Task Force on Preventive Health Care by systematically reviewing direct evidence on the effectiveness and acceptability of screening adults 40 years and older in primary care to reduce fragility fractures and related mortality and morbidity, and indirect evidence on the accuracy of fracture risk prediction tools. Evidence on the benefits and harms of pharmacological treatment will be reviewed, if needed to meaningfully influence the Task Force’s decision-making. Methods A modified update of an existing systematic review will evaluate screening effectiveness, the accuracy of screening tools, and treatment benefits. For treatment harms, we will integrate studies from existing systematic reviews. A de novo review on acceptability will be conducted. Peer-reviewed searches (Medline, Embase, Cochrane Library, PsycINFO [acceptability only]), grey literature, and hand searches of reviews and included studies will update the literature. Based on pre-specified criteria, we will screen studies for inclusion following a liberal-accelerated approach. Final inclusion will be based on consensus. Data extraction for study results will be performed independently by two reviewers while other data will be verified by a second reviewer; there may be some reliance on extracted data from the existing reviews. The risk of bias assessments reported in the existing reviews will be verified and for new studies will be performed independently. When appropriate, results will be pooled using either pairwise random effects meta-analysis (screening and treatment) or restricted maximum likelihood estimation with Hartun-Knapp-Sidnick-Jonkman correction (risk prediction model calibration). Subgroups of interest to explain heterogeneity are age, sex, and menopausal status. Two independent reviewers will rate the certainty of evidence using the GRADE approach, with consensus reached for each outcome rated as critical or important by the Task Force. Discussion Since the publication of other guidance in Canada, new trials have been published that are likely to improve understanding of screening in primary care settings to prevent fragility fractures. A systematic review is required to inform updated recommendations that align with the current evidence base. |
abstractGer |
Abstract Purpose To inform recommendations by the Canadian Task Force on Preventive Health Care by systematically reviewing direct evidence on the effectiveness and acceptability of screening adults 40 years and older in primary care to reduce fragility fractures and related mortality and morbidity, and indirect evidence on the accuracy of fracture risk prediction tools. Evidence on the benefits and harms of pharmacological treatment will be reviewed, if needed to meaningfully influence the Task Force’s decision-making. Methods A modified update of an existing systematic review will evaluate screening effectiveness, the accuracy of screening tools, and treatment benefits. For treatment harms, we will integrate studies from existing systematic reviews. A de novo review on acceptability will be conducted. Peer-reviewed searches (Medline, Embase, Cochrane Library, PsycINFO [acceptability only]), grey literature, and hand searches of reviews and included studies will update the literature. Based on pre-specified criteria, we will screen studies for inclusion following a liberal-accelerated approach. Final inclusion will be based on consensus. Data extraction for study results will be performed independently by two reviewers while other data will be verified by a second reviewer; there may be some reliance on extracted data from the existing reviews. The risk of bias assessments reported in the existing reviews will be verified and for new studies will be performed independently. When appropriate, results will be pooled using either pairwise random effects meta-analysis (screening and treatment) or restricted maximum likelihood estimation with Hartun-Knapp-Sidnick-Jonkman correction (risk prediction model calibration). Subgroups of interest to explain heterogeneity are age, sex, and menopausal status. Two independent reviewers will rate the certainty of evidence using the GRADE approach, with consensus reached for each outcome rated as critical or important by the Task Force. Discussion Since the publication of other guidance in Canada, new trials have been published that are likely to improve understanding of screening in primary care settings to prevent fragility fractures. A systematic review is required to inform updated recommendations that align with the current evidence base. |
abstract_unstemmed |
Abstract Purpose To inform recommendations by the Canadian Task Force on Preventive Health Care by systematically reviewing direct evidence on the effectiveness and acceptability of screening adults 40 years and older in primary care to reduce fragility fractures and related mortality and morbidity, and indirect evidence on the accuracy of fracture risk prediction tools. Evidence on the benefits and harms of pharmacological treatment will be reviewed, if needed to meaningfully influence the Task Force’s decision-making. Methods A modified update of an existing systematic review will evaluate screening effectiveness, the accuracy of screening tools, and treatment benefits. For treatment harms, we will integrate studies from existing systematic reviews. A de novo review on acceptability will be conducted. Peer-reviewed searches (Medline, Embase, Cochrane Library, PsycINFO [acceptability only]), grey literature, and hand searches of reviews and included studies will update the literature. Based on pre-specified criteria, we will screen studies for inclusion following a liberal-accelerated approach. Final inclusion will be based on consensus. Data extraction for study results will be performed independently by two reviewers while other data will be verified by a second reviewer; there may be some reliance on extracted data from the existing reviews. The risk of bias assessments reported in the existing reviews will be verified and for new studies will be performed independently. When appropriate, results will be pooled using either pairwise random effects meta-analysis (screening and treatment) or restricted maximum likelihood estimation with Hartun-Knapp-Sidnick-Jonkman correction (risk prediction model calibration). Subgroups of interest to explain heterogeneity are age, sex, and menopausal status. Two independent reviewers will rate the certainty of evidence using the GRADE approach, with consensus reached for each outcome rated as critical or important by the Task Force. Discussion Since the publication of other guidance in Canada, new trials have been published that are likely to improve understanding of screening in primary care settings to prevent fragility fractures. A systematic review is required to inform updated recommendations that align with the current evidence base. |
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Screening to prevent fragility fractures among adults 40 years and older in primary care: protocol for a systematic review |
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Jennifer Pillay Guylène Thériault Heather Limburg Roland Grad Scott Klarenbach Christina Korownyk Donna Reynolds John J. Riva Brett D. Thombs Gregory A. Kline William D. Leslie Susan Courage Ben Vandermeer Robin Featherstone Lisa Hartling |
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Jennifer Pillay Guylène Thériault Heather Limburg Roland Grad Scott Klarenbach Christina Korownyk Donna Reynolds John J. Riva Brett D. Thombs Gregory A. Kline William D. Leslie Susan Courage Ben Vandermeer Robin Featherstone Lisa Hartling |
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