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Osteoporosis (fragility fracture risk assessment + pragmatic treatment pathways)

A Canadian clinical summary of osteoporosis (fragility fracture risk assessment + pragmatic treatment pathways), with source-attributed priorities and explicit jurisdiction boundaries.

JurisdictionCanada
Source check2026-08-20
Clinical reviewiatroX editorial team 路 Clinical editorial review 路 reviewed 2026-08-20 路 due 2027-08-20
AudienceHealthcare professionals practising in Canada
This is an iatroX educational summary of named Canada sources, not an official guideline. It does not replace the complete source documents, local policy, specialist advice or clinical judgement. The evidence source is pan-Canadian, but formularies, funded access, referral routes, public-health directions and service availability remain provincial or territorial.

Source and scope

This summary is bounded to the recommendations, population and decisions covered by 2023 Clinical Practice Guideline for Management of Osteoporosis and Fracture Prevention in Canada. Apply it with the current provincial or territorial pathway where implementation differs.
sources for this section:OC 2023

Source-attributed clinical priorities

  • Identify prior fragility fracture, falls, glucocorticoids and other clinical risk factors and obtain bone density when it changes management.
  • Use the 2023 Canadian fracture-risk approach to decide pharmacotherapy and select an agent by risk, kidney function and patient factors.
  • Plan calcium and vitamin D adequacy, exercise and falls care, adherence checks and a defined reassessment or transition strategy.
  • A hip or vertebral fragility fracture generally establishes high future fracture risk independent of bone density.
sources for this section:OC 2023

Practical assessment and management workflow

1
Record prior fractures, falls, height loss, glucocorticoids, menopause, nutrition, alcohol, smoking and secondary causes.
2
Measure bone density when it will change management and calculate Canadian fracture risk correctly.
3
Address exercise, fall prevention, calcium and vitamin D adequacy and select medicine by risk and kidney function.
4
Plan adherence review, repeat risk assessment and a safe transition before stopping denosumab.
sources for this section:OC 2023

Safety, red flags and urgent escalation

  • New severe back pain with neurologic change requires assessment for unstable vertebral fracture or compression.
  • Do not stop denosumab without follow-on antiresorptive planning because rebound vertebral fractures can occur.
  • Review dental, renal, hypocalcemia and atypical-fracture risks without delaying clearly beneficial treatment unnecessarily.
sources for this section:OC 2023

Confirm the local pathway before acting

The evidence source is pan-Canadian, but formularies, funded access, referral routes, public-health directions and service availability remain provincial or territorial.
sources for this section:OC 2023

Source and implementation boundary

Read this educational summary with the linked source, current Canadian product information where medicines are involved, and the applicable provincial or territorial pathway. Local formularies, reporting duties, referral routes and service availability can differ.
sources for this section:OC 2023

Source documents

Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.

  1. Osteoporosis Canada2023 Clinical Practice Guideline for Management of Osteoporosis and Fracture Prevention in Canadaaccessed 2026-08-20
    view source
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