Our neighbors to the north take the lead!

Recent changes to Osteoporosis Canada’s 2010 Clinical Practice Guidelines mean that deciding who needs a bone medication will now depend on a multi-factorial fracture risk assessment, rather than on simple bone density testing. Canadian doctors will be looking at previous fractures, family history, alcohol use, smoking, and other factors including a physical exam to assess who needs bone medication. And doesn’t this make good sense? It is well documented that having multiple risk factors is a much more powerful predictor of fracture than low bone density.

What this means is that fewer women in Canada are being classified as being at “high risk” of fracture and more are classified as being at “low” or “moderate” risk, as reported recently in the Annals of Internal Medicine. This is important because those at “high risk” of fracture are the most appropriate candidates for bone drugs. For lower risk patients, alternatives like exercise, fall prevention, and calcium and vitamin D supplementation are suggested. The end result is that fewer Canadian women will be told to take osteoporosis medications.

The move away from using bone drugs for low and moderate risk individuals is a progressive policy step I applaud. Over the years, I have noticed that Canadian osteoporosis agencies have taken a commendable science-based, public-interest approach to the burden of needless fragility fractures. Now, once again, our neighbors to the north take the lead — this time in the implementation of a more rational way to decide who should be given drugs for their bones.

I also congratulate Osteoporosis Canada for recommending physicians conduct biochemical testing on those at risk of fracture — the very similar medical osteoporosis work-up I have been recommending that doctors do for some time. This kind of testing allows us to get at the root of bone loss, rather than simply covering it up with a drug.

Hail Canada — thanks for leading the way, again!

• To assess your fracture risk, see our Bone Health Profile.
• For more on biochemical testing for those at risk of fracture, see my medical testing for osteoporosis article.
• For more on risk, see the fracture risk chart created by the Canadian Association of Radiologists and Osteoporosis Canada.

References:

Leslie, WD, Morin, S, & Lix, LM. 2010. A before-and-after study of fracture risk reporting and osteoporosis treatment initiation. Ann Internal Med, 153(9):580-586.

Papaioannou, A, Morin, S, Cheung, AM, et al. 2010. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: Summary. CMAJ, early release online, Oct. 12, DOI:10.1503/cmaj.100771