Osteoporosis LTC Recommendations

1. Fracture Risk Assessment

Identifying those at high risk of fracture is important to avoid the devastating consequences of bone disease. Knowing your risk will allow for appropriate intervention for both timely prevention and treatment.

How Do I Know My Risk for Fractures?​

Individuals at high risk of fractures are those who meet one of the following:

  • Had a prior fracture of the hip or spine
  • Had more than one prior fracture (excluding fractures of the hands/feet/ankles)
  • Recently used glucocorticoids (e.g. steroids or prednisone)
  • Had been identified as high risk and/or receiving osteoporosis treatment prior to admission

What Should I Know About Fracture Risk Assessment in Long-Term Care​?

  • All residents on admission should be assessed for fractures
  • All residents with osteoporosis should maintain treatments and interventions for their osteoporosis to help minimize the risk for future fractures
  • Always assess for fracture when residents fall
  • Always reassess residents’ fracture risk when they return to long-term care from a hospital following an admission for a fracture

How Can Risk for Fracture Be Assessed in Long-Term Care?

DetermineHow to Assess
Prior hip fractureHave you ever broken your hip?
Prior vertebral fractureHave you lost height?” If YES and > 6 cm historically, order lateral thoratic and lumbar spine?
More than one prior fracture (excluding fractures of the hands/feet/ankle)Have you had a broken bone after 50?
If recently used systemic glucocorticoids and have had one prior fractureAre you using medications such as steroids or prednisone?
If identified as high risk and/or are on osteoporosis treatment prior to admissionHave you been on osteoporosis medications?

Do I Need A Bone Mineral Density Test?

NO. Answering ‘Yes’ to any of the previous questions will have identified you as high risk for fracture. A BMD test is not required to identify individuals at high risk for fracture.

Resources

Dr. Sid Feldman on Osteoporosis (Video)

Learn about the impact of fractures and the importance of screening for risk of fracture.

Key Publications

  • Fracture risk assessment in long-term care: a survey of long-term care physicians [Wall M et al.BMC Ger. 2013]
  • Fracture risk in long-term care: A systematic review and meta-analysis of prospective observational studies [Khatib R et al. BMC Ger. 2014]
  • Individuals with neurological diseases are at increased risk of fractures within 180 days of admission to long-term care in Ontario [Jantzi M et al. Age Ageing. 2015]