Osteoporosis LTC Recommendations

The fracture prevention guidelines are the first guideline in Canada focused on preventing fractures among frail older adults in long-term care. Whether older adults are living in the community or in long-term care homes, the guidelines will help minimize their risk of fracture.


The guideline, Recommendations for Preventing Fracture in Long-Term Care, is the first guideline in Canada focused on preventing fractures among the frail and elderly in long-term care, where fractures are much more common than among community-dwelling seniors. Launched in 2015, the guideline is specifically designed to reduce immobility, pain, hospital transfers and most importantly, improve the quality of life of residents at these facilities.

The guideline contains valuable, practical information, such as strategies to prevent fractures, useful for doctors, caregivers and frail older adults at long-term care facilities and in the community. These strategies are:

  • Appropriate calcium and vitamin D intake
  • Use of hip protectors
  • Exercise
  • Multifactorial interventions to prevent falls and osteoporosis medication.

How to Interpret the Guidelines


Strong Recommendation

“we recommend” …

Conditional Recommendation

“we suggest”…

For patients/

Most individuals in this situation would want the recommended course of action, and only a small proportion would not

The majority of individuals in this situation would want the suggested course of action, but many would not

For clinicians

Most individuals should receive the intervention

Clinicians recognize that different choices will be appropriate for each individual and that they must help each individual arrive at a management decision consistent with his/her values and preferences

Why a Guideline

The recommendations filled an existing gap in the care of frail older adults: existing fracture risk assessment tools have not been validated in long-term care, and current clinical practice guidelines for osteoporosis focus on the care of adults living in the community. One-third of older adults who experience hip fractures are residents in long-term care. The overall fracture rate among long-term care residents is two to four times that of similarly-aged adults living in the community. Yet, despite the availability of therapies, many residents are not being treated after fracture.​

In addition, frail and elderly adults have multiple medical issues. The proposed recommendations integrate falls and osteoporosis assessment, taking into consideration lifespan, renal impairment and risk of falls and fracture.

How They Were Developed

Fracture prevention recommendations for long-term care were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, and considered the quality of the available evidence, the balance between benefits and harms, the preferences of residents and their care providers’, as well as the resources required to implement them. 

Recommendations for interventions to prevent fracture were developed for older residents both at high risk and not at high risk of fracture. Residents identified at high risk of fracture based on the 2010 Osteoporosis Canada Guidelines include those who have had a prior fracture of hip or spine, have had more than one prior fracture, or have recently used glucocorticoids and have had one prior fracture. 

The proposed treatment recommendations integrate falls and osteoporosis assessment, taking into consideration lifespan, renal impairment, and simultaneous risk of falls and fractures. The recommendations consider various treatment strategies, in addition to osteoporosis medications.

Who They Were Developed By

The guideline was developed by the Scientific Advisory Council of Osteoporosis Canada, led by Dr. Alexandra Papaioannou, a Geriatrician with Hamilton Health Sciences and  Professor, Department of Medicine at McMaster University in conjunction with a team of researchers and health care providers.