• Suzanne N Morin, Sidney Feldman, Larry Funnell, Lora Giangregorio, Sandra Kim, Heather McDonald-Blumer, Nancy Santesso, Rowena Ridout, Wendy Ward, Maureen C Ashe, Zahra Bardai, Joan Bartley, Neil Binkley, Steven Burrell, Debra Butt, Suzanne M Cadarette, Angela M Cheung, Phil Chilibeck, Sheila Dunn, Jamie Falk, Heather Frame, William Gittings, Kaleen Hayes, Carol Holmes, George Ioannidis, Susan B Jaglal, Robert Josse, Aliya A Khan, Virginia McIntyre, Lynn Nash, Ahmed Negm, Alexandra Papaioannou, Matteo Ponzano, Isabel B Rodrigues, Lehana Thabane, Christine A Thomas, Lianne Tile, John D Wark, and Osteoporosis Canada 2023 Guideline Update Group.
• McGill University (Morin), Montréal, Que.; University of Toronto (Feldman, Kim, McDonald-Blumer, Ridout, Cheung, Josse, Tile, Bardai, Butt, Cadarette, Dunn, Jaglal), Toronto, Ont.; patient partners (Funnell, McIntyre, Bartley, Thomas); University of Waterloo (Giangregorio, Kim, McLaughlin, Rodrigues), Waterloo, Ont.; Brock University (Ward, Gittings), St. Catharines, Ont.; McMaster University (Santesso, Ioannidis, Khan, Nash, Thabane, Papaioannou), Hamilton, Ont.; University of Wisconsin (Binkley), Madison, Wisc.; Dalhousie University (Burrell), Halifax, NS; Menzies Medical Centre (Holmes), Morden, Man.; University of Calgary (Negm), Calgary, Alta.; University of British Columbia (Ashe), Vancouver, BC; University of Saskatchewan (Chilibeck), Saskatoon, Sask.; University of British Columbia (Ponzano), Kelowna, BC; University of Melbourne (Wark), Melbourne, Australia; University of Manitoba (Falk, Frame), Winnipeg, Man.; Brown University (Hayes), Providence, RI. suzanne.morin@mcgill.ca.
• CMAJ. 2023 Oct 10; 195 (39): E1333E1348E1333-E1348.

BackgroundIn 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.MethodsThis 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.RecommendationsThe 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.InterpretationThe 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.© 2023 CMA Impact Inc. or its licensors.

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