Osteoporosis affects 1 in 4 Canadian women and 1 in 8 Canadian men. This week, Osteoporosis Canada launches its new guidelines. These new guidelines focus on the identification of those who are at risk for fracture, and the use of new clinical tools to assess that risk.

Here, the goal is to identify patients after their first fragility fracture, and to help doctors better identify and prevent future fractures in their patients, as well as osteoporosis in general. The goal as well, ideally, is to avoid that first fracture as that is the greatest risk factor for future fracture.

If you are over 40 and you have had a fracture as a result of falling from a standing height, you have suffered what is called a fragility fracture. The bottom line is that it is not normal to sustain a fracture from a fall.

Fragility fractures, the consequence of osteoporosis, can have a devastating impact on a person's quality of life, leading to chronic pain, further illness or even death.

Did you know that:

• 80 per cent of all fractures in women over 50 are a result of osteoporosis
• Those with hip or vertebral fractures have substantially increased risk of death post-fracture
• The cost to the Canadian health care system of treating osteoporosis and the fractures it causes is currently estimated to be $1.9 billion annually
• Each hip fracture costs the system $21,285 in the 1st year after hospitalization and $44,156 per year if the patient is institutionalized
• Osteoporotic hip fractures consume more hospital bed days than stroke, diabetes, or heart attack.

Many fracture patients are not appropriately assessed or treated; however, all women and men over age 50 should be assessed for osteoporosis and fracture risk factors to identify those at high risk for fractures.

Despite the high prevalence of fragility fractures in the Canadian population and the known fact that fractures predict future fractures, fewer than 20 per cent of women and between nine and 10 per cent of men receive therapies to prevent further fractures. In contrast, 75 per cent of patients who have had a heart attack currently receive treatment to prevent further heart attacks.

Warning signs of osteoporosis include:

• In people over 50, hip or vertebral (spinal) fractures in the absence of significant trauma to the bone
• Hunched upper back or decrease in height - could signal vertebral fractures
• Family history of fragility fractures

The new guidelines encourage that a broader scope be taken. To that end, 10-year fracture risk prediction tools incorporate clinical risk factors beyond the bone mineral density test or BMD. While the bone mineral density is critical, it is not the only predictor of fracture risk, We  now have tools that are available for use to help decide how best to interpret the score that is gotten when a BMD is done.

As well there is an increased focus on the care gap that exists in the treatment of at-risk individuals. The Canadian WHO Fracture Risk Assessment Tool (FRAX) and the Canadian Association of Radiologist and Osteoporosis Canada (CAROC) risk assessment systems can be used in Canada at the present time.

CAROC allows doctors to predict what the likelihood of fracture is over the next 10 years. FRAX allows a patient or doctor  to go on line and enter a number of criteria to help them assess what their fracture risk might be.

The guidelines also emphasize what Canadians can do to lessen their risk of fracture.

• Higher daily vitamin D supplementation (D3)
  - 400 - 1000 IU for individuals < 50 years
  - 800 - 2000 IU for individuals > 50 years
• Lower daily calcium intake (from all sources): 1200 mg
• For those with or at risk for osteoporosis: appropriate resistance training and/or weight-bearing aerobic exercise.  
• For those with vertebral fractures: directed core stability exercise
• For those at risk of falls: exercises that focus on balance (e.g., Tai chi, balance and/or gait training).

Medication should be offered for those at high risk. Make sure you discuss your bone health with your doctor.

WATCH: My segment on Canada AM: Osteoporosis guidelines