RT Journal Article
SR Electronic
T1 Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E1333
OP E1348
DO 10.1503/cmaj.221647
VO 195
IS 39
A1 Morin, Suzanne N.
A1 Feldman, Sidney
A1 Funnell, Larry
A1 Giangregorio, Lora
A1 Kim, Sandra
A1 McDonald-Blumer, Heather
A1 Santesso, Nancy
A1 Ridout, Rowena
A1 Ward, Wendy
A1 Ashe, Maureen C.
A1 Bardai, Zahra
A1 Bartley, Joan
A1 Binkley, Neil
A1 Burrell, Steven
A1 Butt, Debra
A1 Cadarette, Suzanne M.
A1 Cheung, Angela M.
A1 Chilibeck, Phil
A1 Dunn, Sheila
A1 Falk, Jamie
A1 Frame, Heather
A1 Gittings, William
A1 Hayes, Kaleen
A1 Holmes, Carol
A1 Ioannidis, George
A1 Jaglal, Susan B.
A1 Josse, Robert
A1 Khan, Aliya A.
A1 McIntyre, Virginia
A1 Nash, Lynn
A1 Negm, Ahmed
A1 Papaioannou, Alexandra
A1 Ponzano, Matteo
A1 Rodrigues, Isabel B.
A1 Thabane, Lehana
A1 Thomas, Christine A.
A1 Tile, Lianne
A1 Wark, John D.
A1 
YR 2023
UL http://www.cmaj.ca/content/195/39/E1333.abstract
AB Background: In Canada, more than 2 million people live with osteoporosis, a disease that increases the risk for fractures, which result in excess mortality and morbidity, decreased quality of life and loss of autonomy. This guideline update is intended to assist Canadian health care professionals in the delivery of care to optimize skeletal health and prevent fractures in postmenopausal females and in males aged 50 years and older.Methods: This guideline is an update of the 2010 Osteoporosis Canada clinical practice guideline on the diagnosis and management of osteoporosis in Canada. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and quality assurance as per Appraisal of Guidelines for Research and Evaluation (AGREE II) quality and reporting standards. Primary care physicians and patient partners were represented at all levels of the guideline committees and groups, and participated throughout the entire process to ensure relevance to target users. The process for managing competing interests was developed before and continued throughout the guideline development, informed by the Guideline International Network principles. We considered benefits and harms, patient values and preferences, resources, equity, acceptability and feasibility when developing recommendations; the strength of each recommendation was assigned according to the GRADE framework.Recommendations The 25 recommendations and 10 good practice statements are grouped under the sections of exercise, nutrition, fracture risk assessment and treatment initiation, pharmacologic interventions, duration and sequence of therapy, and monitoring. The management of osteoporosis should be guided by the patient’s risk of fracture, based on clinical assessment and using a validated fracture risk assessment tool. Exercise, nutrition and pharmacotherapy are key elements of the management strategy for fracture prevention and should be individualized.Interpretation: The aim of this guideline is to empower health care professionals and patients to have meaningful discussions on the importance of skeletal health and fracture risk throughout older adulthood. Identification and appropriate management of skeletal fragility can reduce fractures, and preserve mobility, autonomy and quality of life.