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Contexte: Au Canada, plus de 2 millions de personnes vivent avec l'osteoporose, une maladie qui accroTt le risque de fracture, ce qui fait augmenter la morbidite et la mortalite, et entraTne une perte de qualite de vie et d'autonomie. La presente actualisation des lignes directrices vise a accompagner les professionnelles et professionnels de la sante au Canada dans la prestation de soins visant a optimiser la sante osseuse et a prevenir les fractures chez les femmes menopausees et les hommes de 50 ans et plus. Methodes: Le present document fournit une actualisation des lignes directrices de pratique clinique de 2010 d'Osteoporose Canada sur le diagnostic et la prise en charge de l'osteoporose au pays. Nous avons utilise l'approche GRADE (Grading of Recommendations Assessment, Development and Evaluation) et effectue l'assurance de la qualite conformement aux normes de qualite et de presentation des rapports de la grille AGREE II (Appraisal of Guidelines for Research & Evaluation). Les medecins de premier recours et les patientes et patients partenaires ont ete representes a tous les niveaux des comites et des groupes ayant participe a l'elaboration des lignes directrices, et ont participe a toutes les etapes du processus pour garantir la pertinence des informations pour les futurs utilisateurs et utilisatrices. Le processus de gestion des interets concurrents a ete entame avant l'elaboration des lignes directrices et s'est poursuivi sur toute sa duree, selon les principes du Reseau international en matiere de lignes directrices. Dans la formulation des recommandations, nous avons tenu compte des avantages et des risques, des valeurs et preferences de la patientele, des ressources, de l'equite, de l'acceptabilite et de la faisabilite; la force de chacune des recommandations a ete determinee en fonction du cadre GRADE. Recommandations: Les 25 recommandations et les 10 enonces de bonne pratique sont repartis en sections: activite physique, alimentation, evaluation du risque de fracture, instauration du traitement, interventions pharmacologiques, duree et sequence du traitement, et monitorage. La prise en charge de l'osteoporose devrait se fonder sur le risque de fracture, etabli au moyen d'une evaluation clinique realisee avec un outil d'evaluation du risque de fracture valide. L'activite physique, l'alimentation et la pharmacotherapie sont des elements essentiels a la strategie de prevention des fractures, qui devraient etre personnalises. Interpretation: Les presentes lignes directrices ont pour but d'outiller les professionnelles et professionnels de la sante et la patientele afin qu'ensemble ils puissent parler de l'importance de la sante osseuse et du risque de fracture tout au long de la vie adulte avancee. La detection et la prise en charge efficace de la fragilite osseuse peuvent contribuer a reduire les fractures et a preserver la mobilite, l'autonomie et la qualite de vie., Le risque de fracture augmente avec l'age, en raison du declin de la robustesse squelettique et de l'augmentation du risque de chute. Au Canada, plus de 2 millions de personnes [...]

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., Fracture risk increases with advancing age, as a result of declining skeletal strength and increased risk of falling. In Canada, more than 2 million people live with osteoporosis. (1) Every [...]

Apres un recent expose que j'ai presente lors d'une conference nationale de medecins canadiens, j'ai examine les evaluations transmises par les personnes participantes. Alors que plusieurs parlaient de ce qu'elles [...]

Anti-osteoporosis treatments reduce fracture risk but maybe associated with rare adverse events with long-term use such as atypical femoral fractures (AFFs) and medication-related osteonecrosis of the jaw (MRONJ). AFFs are rare but more likely with prolonged bisphosphonate use, whereas MRONJ incidence is higher in cancer patients on high-dose antiresorptive therapy. Following diagnosis, effective treatment options are available to manage both of these rare complications. An individualized treatment approach is advised with close monitoring.

Osteoporotic fractures, also known as fragility fractures, are reflective of compromised bone strength and are associated with significant morbidity and mortality. Such fractures may be clinically silent, and others may present clinically with pain and deformity at the time of the injury. Unfortunately, and even at the time of detection, most individuals sustaining fragility fractures are not identified as having underlying metabolic bone disease and are not evaluated or treated to reduce the incidence of future fractures. A multidisciplinary international working group with representation from international societies dedicated to advancing the care of patients with metabolic bone disease has developed best practice recommendations for the diagnosis and evaluation of individuals with fragility fractures. A comprehensive narrative review was conducted to identify key articles on fragility fractures and their impact on the incidence of further fractures, morbidity, and mortality. This document represents consensus among the supporting societies and harmonizes best practice recommendations consistent with advances in research. A fragility fracture in an adult is an important predictor of future fractures and requires further evaluation and treatment of the underlying osteoporosis. It is important to recognize that most fragility fractures occur in patients with bone mineral density T scores higher than −2.5, and these fractures confirm the presence of skeletal fragility even in the presence of a well-maintained bone mineral density. Fragility fractures require further evaluation with exclusion of contributing factors for osteoporosis and assessment of clinical risk factors for fracture followed by appropriate pharmacological intervention designed to reduce the risk of future fracture. Because most low-trauma vertebral fractures do not present with pain, dedicated vertebral imaging and review of past imaging is useful in identifying fractures in patients at high risk for vertebral fractures. Given the importance of fractures in confirming skeletal fragility and predicting future events, it is recommended that an established classification system be used for fracture identification and reporting.

Background. Regular exercise is advocated in osteoporosis guidelines to prevent fractures. Few studies have evaluated the effect of exercise on functional performance, posture, and other outcomes that are important to patients after vertebral fractures. Objective. This pilot study will explore the effect of home exercise versus control on functional performance, posture, and patient-reported outcome measures. Design. This study was a parallel 2-arm pilot feasibility trial with 1:1 randomization to exercise or attentional control groups. Setting. This study took place in 5 Canadian and 2 Australian academic or community hospitals/centers. Participants. This study included 141 women [greater than or equal to]65 years of age with radiographically confirmed vertebral fractures. Intervention. A physical therapist delivered exercise and behavioral counseling in 6 home visits over 8 months and monthly calls. Participants were to exercise [greater than or equal to]3 times weekly. Controls received equal attention. Measurements. Functional performance, posture, quality of life, pain, and behavior-change outcomes were assessed at baseline and after 6 (questionnaires only) and 12 months. Adherence to exercise was assessed by calendar diary. All t tests examined between-group mean differences (MD) in change from baseline in intention-to-treat and per-protocol analyses. Results. There was a small effect of exercise on 5 times sit-to-stand test versus control (MD = -1.58 [95% CI = -3.09 to -0.07], intention-to-treat; MD = -1.49 [95% CI = -3.12 to 0.16], per-protocol). There were no other major or statistically significant MDs for any other measured outcomes after follow-up. Adherence declined over time. Limitations. Treatment effects on variables may have been underestimated due to multiple comparisons and underpowered analyses. Conclusions. Our exploratory estimate of the effect of exercise on functional leg muscle strength was consistent in direction and magnitude with other trials in individuals with vertebral fractures. Declining adherence to home exercise suggests that strategies to enhance long-term adherence might be important in future confirmatory trials., Osteoporotic vertebral fractures are associated with significant health and economic burden worldwide (1,2) and can lead to functional decline, (3) pain, (4) reduced quality of life, (5) hospitalization, (6) and [...]