Hub: Periodic health assessment
Osteoporosis
Treatment numbers are Osteoporosis Canada 2023.
Screening
Screening differs- CTFPHC Canadian Task Force on Preventive Health Care
- OC Osteoporosis Canada
- INESSS Institut national d'excellence en santé et services sociaux
| Decision | Guideline |
|---|---|
| Who | F≥65 risk-first Canadian clinical FRAX without BMD, then SDM.BMD if considering preventive pharmacotherapy.
Against screening F40-64 and M≥40 (strong). Prefer FRAX with BMD.BMD if 50-64 prior OP fracture or ≥2 CRFs;
≥65 with 1 CRF;
≥70 even with no CRF. Osteoporosis Canada 2023 CMAJ opens in a new tabOC executive summary opens in a new tab |
| Clinical risk factors | |
| How CRFs used | No CRF-count BMD gate.Women ≥65: FRAX without BMD first.
Against population screening in women 40-64 and men ≥40 even when CRFs are present (strong).
Remain clinically alert. CRFs + age decide BMD.Ages 50-64: BMD if prior OP fracture or ≥2 CRFs.
≥65: BMD if ≥1 CRF.
≥70: BMD even with no CRF.
Then FRAX with BMD. Osteoporosis Canada 2023 CMAJ opens in a new tabOC executive summary opens in a new tab |
| Parental hip fracture (FDR) | FRAX input.Parental hip fracture is a FRAX clinical-risk input.
It does not create a CTFPHC BMD gate. Parental hip fracture.CMAJ Figure 1 CRF used with age to decide BMD. Either biological parent.Tableau 1: hip fracture in either biological parent. |
| Prior fragility / OP-related fracture | FRAX input After age 40; recency 2 years.Prior OP-related fracture after age 40.
Recency matters, especially within 2 years. Site exclusions.Tableau 1 excludes finger, metatarsal, craniofacial, rib, and ankle fractures. |
| Glucocorticoids | FRAX input CMAJ Figure 1.>3 mo in the last year, prednisone >5 mg/d. |
| Secondary osteoporosis | FRAX input CMAJ appendix.Other causes of secondary osteoporosis — see the CMAJ appendix. Tableau 1 closed list.Protocol list only. Not an OC appendix merge.
Patient + chart/DSQ only
|
| Smoking and alcohol | FRAX input.Current smoking and high alcohol intake are FRAX clinical-risk inputs. Current smoking.
High alcohol intake..CMAJ Figure 1 CRF. Active smoking.
≥3 drinks/d.Tableau 1.
One drink: regular beer, or wine 125 ml, or 1 oz spirits. |
| Falls last 12 months | Not a FRAX checkbox.Falls are not a FRAX clinical-risk checkbox on the CTFPHC path. ≥1 fall in the last 12 months.CMAJ Figure 1 CRF.
OC notes FRAX may underestimate recurrent falls. Not a Tableau 1 row.Falls are not listed as a Tableau 1 clinical-risk factor. |
| BMI <20 | FRAX input.Height and weight enter FRAX.
BMI <20 is not a separate CTFPHC screening gate. BMI <20 kg/m².CMAJ Figure 1 CRF used with age to decide BMD. Height and weight for FRAX.Tableau 1 uses height and weight for FRAX.
BMI <20 is not a named Tableau 1 row. |
| Age / sex gates | Screen path: women ≥65 only.CRFs do not override the recommendation against population screening in men ≥40 and women 40-64. Postmenopausal women and men ≥50.BMD rules in Who: 50-64 / ≥65 / ≥70 with CRF counts. |
| Treat category | Not a raw CRF tally.OC treatment bands use fracture history plus 10-year MOF and T-score (Diagnose).
CRFs feed FRAX/CAROC and BMD eligibility — they do not themselves set the treat category. Osteoporosis Canada 2023 CMAJ opens in a new tabOC executive summary opens in a new tab |
Diagnose
- OC Osteoporosis Canada
| Decision | Guideline |
|---|---|
| Recommend treat | |
| Prior hip, vertebra, or ≥2 OP fractures | Recommend pharmacotherapy Osteoporosis Canada 2023 CMAJ opens in a new tabOC executive summary opens in a new tab |
| ≥20% | Recommend pharmacotherapy Osteoporosis Canada 2023 CMAJ opens in a new tabOC executive summary opens in a new tab |
| Age ≥70 and T ≤ -2.5 | Recommend pharmacotherapy Osteoporosis Canada 2023 CMAJ opens in a new tabOC executive summary opens in a new tab |
| Suggest treat | |
| 15–19.9% | Suggest pharmacotherapy Osteoporosis Canada 2023 CMAJ opens in a new tabOC executive summary opens in a new tab |
| Age <70 and T ≤ -2.5 | Suggest pharmacotherapy Osteoporosis Canada 2023 CMAJ opens in a new tabOC executive summary opens in a new tab |
| Low risk | Do not treat (Choosing Wisely rheumatology). Choosing Wisely rheumatology opens in a new tabOsteoporosis Canada 2023 CMAJ opens in a new tab |
Investigate
- OC Osteoporosis Canada
| Decision | Guideline |
|---|---|
| FRAX | FRAX with BMD preferred.CAROC is an alternate. Osteoporosis Canada 2023 CMAJ opens in a new tabOC executive summary opens in a new tab |
| Vertebral imaging | Lateral thoracic and lumbar radiographs if clinical vertebral fracture, or FRAX 15–19%, or age ≥65 with T ≤ -2.5. Osteoporosis Canada 2023 CMAJ opens in a new tabOC executive summary opens in a new tab |
| Baseline labs if treating | Before pharmacotherapy
If vertebral fracture
If deficiency risk
Osteoporosis Canada 2023 CMAJ opens in a new tabOC executive summary opens in a new tab |
Treat
- OC Osteoporosis Canada
| Decision | Guideline |
|---|---|
| First drugs | Alendronate, risedronate, or zoledronic acid first.Initial bisphosphonate 3–6 y then holiday. Osteoporosis Canada 2023 CMAJ opens in a new tabOC executive summary opens in a new tab |
| Denosumab | If bisphosphonate contraindicated, intolerance, or barriers.q6 mo; do not delay >1 month.
Long-term uninterrupted therapy. Osteoporosis Canada 2023 CMAJ opens in a new tabOC executive summary opens in a new tab |
| MHT | Alternative if <60 or <10 y from menopause, prioritizing VMS Osteoporosis Canada 2023 CMAJ opens in a new tabOC executive summary opens in a new tab |
| Calcium and vitamin D | No extra calcium if diet meets the RDA
OC 2023 nutrition opens in a new tabHealth Canada vitamin D opens in a new tabHealth Canada calcium opens in a new tab |
| Drug | Dose | How often |
|---|---|---|
| First-line bisphosphonate | ||
| Alendronate | 70 mg PO | 1×/sem |
| Risedronate | 35 mg PO | 1×/sem |
| Zoledronic acid | 5 mg IV | Q1 an |
| If bisphosphonate contraindicated | ||
| Denosumab | 60 mg SC | q6 mo |
Follow-up
- CTFPHC Canadian Task Force on Preventive Health Care
- OC Osteoporosis Canada
| Decision | Guideline |
|---|---|
| Not treating | Repeat BMD and FRAX by MOF band
Osteoporosis Canada 2023 CMAJ opens in a new tabOC executive summary opens in a new tab |
| On therapy | BMD at 3 y.After a bisphosphonate holiday, repeat BMD at 3 y.
Osteoporosis Canada 2023 CMAJ opens in a new tabOC executive summary opens in a new tabChoosing Wisely rheumatology opens in a new tab |
| Rescreen interval | Unknown how often to rescreen eligible females.Rescreening within 8 y does not appear useful. |
Reviewed 13 September 2026 against the official sources below.
Sources
Blue square: Québec · red round: Canada. The code names the body; each section's key gives its full name.