Comprehensive update to osteoporosis guideline focuses on fracture prevention

New Canadian guidelines for skeletal health aim to assist healthcare professionals in screening for risk factors for osteoporosis and fractures and provide interventions to optimize skeletal health and fracture prevention. This update to the 2010 guideline, from Osteoporosis Canada and published in the CMAJ, presents 25 recommendations and 10 good practice statements with a focus on postmenopausal women, and men aged 50 years and older. It contains sections on exercise, nutrition, fracture risk assessment, treatment and more, reflecting advances in risk assessment, and nonpharmacologic and pharmacologic management of osteoporosis. The authors noted that in Canada, there are more than 2 million people living with osteoporosis, and every year, about 150 people per 100,000 suffer a hip fracture, commonly leading to increased morbidity, excess mortality, decreased quality of life and loss of autonomy. “Although osteoporosis is often considered a disease of older females, males are remarkably under-evaluated and undertreated for the condition despite suffering worse outcomes following fracture, highlighting the importance of providing guidance in males,” the authors wrote. The guideline is based on the latest evidence and included patient partners in developing the recommendations. Read: Be aware of possibility of acute uveitis after IV zoledronate for osteoporosis Key points of the comprehensive guideline include: Prior fracture is a strong risk predictor of subsequent fracture (particularly in the subsequent 12 to 24 months) The management of osteoporosis should be guided by a validated fracture risk assessment tool. An individualized approach is best: Exercise, nutrition, fall prevention and pharmacotherapy are key elements of a customized management strategy for fracture prevention. Clinicians and patients should collaborate in developing care plans, with patient preferences, goals and capabilities in mind. Recommendation highlights Exercise: Create a plan for balance and functional training at least twice a week to reduce the risk of falls; progressive resistance (strength) training at least twice a week, including exercises targeting abdominal and back extensor muscles. Nutrition: No supplementation is needed for people who meet the recommended dietary allowance for calcium with a variety of calcium-rich foods. Follow Health Canada’s recommendation on vitamin D for bone health: 600 IU/d (age 51 to 70) and 800 IU/d (age > 70 yr) for males and females. Fracture risk assessment: A clinical assessment for osteoporosis and fracture that includes identifying risk factors and assessing for signs of undiagnosed vertebral fracture(s) is recommended. This includes BMD testing in postmenopausal females and males who are: age 50-64 years with a previous osteoporosis-related fracture or ≥ 2 clinical risk factors OR age ≥ 65 years with 1 clinical risk factor for fracture OR age ≥ 70 years Pharmacotherapy is an important component of fracture prevention management and should be individualized, the authors stated. The guideline includes detailed recommendations on pharmacological interventions and their duration, sequence and monitoring. "We are hopeful that this Canadian guideline will empower health care professionals and patients to have meaningful discussions on the importance of skeletal health and fracture prevention to preserve mobility and autonomy across adulthood," said Dr. Suzanne Morin, lead author and chair of the guideline steering committee, in a release. The team is also developing knowledge transfer tools to support patients and clinicians in their discussions on exercise, nutrition, fracture risk and osteoporosis treatment, including a free digital mobile application to provide point of care and educational support. Read: Updated U.S. guidelines for treatment of osteoporosis or low bone mass

Comprehensive update to osteoporosis guideline focuses on fracture prevention

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