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About too fit to fracture

What is Too Fit to Fracture?

Too Fit to Fracture is a series of exercise recommendations for people with osteoporosis or spine fractures. It was developed by expert consensus using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method, which is endorsed by the World Health Organization and the Cochrane Collaboration, to determine the quality of evidence for each recommendation in the existing scientific literature. The strength of the recommendations (strong, conditional, or no recommendation) and the direction (for or against) took into consideration the quality of the available evidence, the balance between the benefits and risks associated with exercise, and the patient groups’ values and preferences. The Too Fit to Fracture expert panel included researchers and clinicians from Australia, Canada, Finland, and the USA, as well as partners from Osteoporosis Canada.

Who developed Too Fit to Fracture?

Dr. Lora Giangregorio
Department of Kinesiology, University of Waterloo

Dr. Alexandra Papaioannou
Department of Medicine, McMaster University
Scientific Director, Geriatric Education and Research in Aging Sciences (GERAS) Centre

Dr. Norma MacIntyre
School of Rehabilitation Sciences, McMaster University

Dr. Maureen Ashe
Department of Family Practice, University of British Columbia

Dr. Ari Heinonen
Department of Health Sciences, University of Jyväskylä

Dr. Kathy Shipp
Department of Community and Family Medicine, Duke University

Dr. John Wark
Department of Medicine, University of Melbourne

Dr. Stuart McGill
Department of Kinesiology, University of Waterloo

Dr. Heather Keller
Department of Kinesiology, University of Waterloo

Mr. Ravi Jain
Director, Ontario Osteoporosis Strategy, Osteoporosis Canada

Dr. Judi Laprade
Division of Anatomy, University of Toronto

Dr. Angela Cheung
Department of Medicine, University of Toronto


Giangregorio, L. M., McGill, S., Wark, J. D., Laprade, J., Heinonen, A., Ashe, M. C., … Papaioannou, A. (2015). Too Fit To Fracture: outcomes of a Delphi consensus process on physical activity and exercise recommendations for adults with osteoporosis with or without vertebral fractures. Osteoporosis International.
Giangregorio, L. M., Papaioannou, A., MacIntyre, N. J., Ashe, M. C., Heinonen, A., Shipp, K., … Cheung, A. M. (2014). Too Fit to Fracture: Exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporosis International.

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