Quick Reference Guide

Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update.

This executive summary has been developed to provide healthcare professionals with a quick-reference summary of the key recommendations from the Clinical Practice Guideline for Management of Osteoporosis and Fracture Prevention in Canada: 2023 Update.

This guideline is an update of the 2010 Osteoporosis Canada clinical practice guideline on the diagnosis and management of osteoporosis in Canada. Consult the full guideline document at osteoporosis.ca/cpg.

Exercise and Nutrition Recommendations

Exercise: Balance, functional training and progressive resistance training > twice weekly to reduce the risk of falls and maintain, or improve physical functioning, quality of life and bone strength.

Calcium: Suggest eating calcium rich foods to meet the recommended dietary allowance for calcium
(Females >50: 1200 mg/day; males 50 – 70: 1000 mg/day; males >70: 1200 mg day.)

Vitamin D: Suggest minimum 400 IU supplement daily along with consuming vitamin D rich foods to meet the recommended dietary allowance for vitamin D 600 IU/d (age 51–70 yr) and 800 IU/d (age > 70 yr) for males and females.

Recommendations for Clinical Assessment

Assessment

Recommended Elements

History

● Identify risk factors for low BMD, fractures and falls:

Risk factors

__ Previous fragility fracture, after age 40

__ Glucocorticoids (> 3 months in the last year, prednisone dose > 5mg daily)¹

__ Falls, ≥ 2 in the last year

__ Parent fractured hip

__ Body Mass Index < 20 kg/m2

__ Secondary osteoporosis¹

__ Current smoking

__ Alcohol ≥ 3 drinks/day

Physical Exam

● Prospective height loss> 2 cm or historical > 6 cm

● Rib to pelvis distance < 2 finger-breadths

● Occiput to wall distance > 5 cm

● Assessment of falls risk: https://worldfallsguidelines.com/algorithm

Indications for BMD Testing

Screening BMD starts at age 70 if no risk factors
Age 65-69 yrs with 1 risk factor
Age 50-64 yrs with prior fracture or ≥ 2 risk factors

Indications for Pharmacotherapy⁺⁺⁺

Calculate 10-year fracture risk with BMD with FRAX (preferred) or CAROC.

¹ Conditions known to cause secondary osteoporosis (Appendix 1, supplemental Table 5); consider referral to specialists with expertise for co-management

⁺⁺⁺To view the full Algorithm and other tools visit osteoporosis.ca/cpg