Canadian guidelines to help prevent fragility fractures in residents at long-term care homes

Osteoporosis Canada announced the release of the first-ever national guideline on preventing fractures in long-term care homes, where fractures are significantly more common than among seniors in the community.

Adapted from Osteoporosis Canada's press release of September 4, 2015

The guideline 'Recommendations for Preventing Fracture in Long-Term Care', offers healthcare professionals, residents of long-term care homes and their families, guidance to help take measures to reduce immobility, pain, hospital transfers and improve the quality of life for residents at long-term care homes. 

Dr. Alexandra Papaioannou, lead author and Professor of Medicine, Division of Geriatric Medicine, McMaster University, said

One-third of older adults who experience hip fractures, and many others who experience different types of fracture, are residents in long-term care homes. Yet, in many cases, these fractures can be prevented,These recommendations fill a much needed gap in the current care of residents of long-term care homes, and will help improve the treatment and care for one of Canada's most at-risk patient populations."

The fracture rate for residents at long-term care homes is two to four times that of similarly-aged adults living in the community.1 Fragility fractures, a type of fracture that occurs from normal activities, are a direct consequence of osteoporosis and can be devastating for long-term care residents and their families. Fragility fractures inflict residents with chronic pain, immobility and even death, and have a debilitating impact on the quality of life. In fact, nearly half the number of women living in long-term care residences who suffer a hip fracture will die within one year.2 Fractures from osteoporosis also have significant economic costs to the Canadian healthcare system and despite the availability of therapies, many residents are not being treated after fracture.3,4,5,6,7,8

Five key strategies

The guideline outlines five strategies to prevent fractures in residents of long-term care homes. These include:

  • Vitamin D and calcium intake
  • Hip protectors,
  • Exercise 
  • Multifactorial interventions to prevent falls
  • Osteoporosis medications 

Breaking a hip, particularly for an elderly person, has a dramatic, detrimental impact on a person's life, robbing them of their independence and causing disabling pain,"

said Dr. Famida Jiwa, President and CEO, Osteoporosis Canada.

With the release of this guideline, Osteoporosis Canada is leading the way in providing staff and residents of long-term care homes with practical tools and advice to not only prevent fracture, but reduce immobility and pain and improve quality of life."

The Recommendations for Preventing Fracture in Long-Term Care were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The guideline panel was comprised of the authors and other multidisciplinary health care providers, researchers and is the first guideline for preventing fractures to include the views of long-term care residents and their families in its development.

View the full guideline, available on the Canadian Medical Association Journal website

Osteoporosis Canada

Osteoporosis Canada, a registered charity, is the only national organization serving people who have or are at risk of osteoporosis. In keeping with our version of a Canada without osteoporosis fractures and falls, the organization works to educate, empower and support individuals and communities in the risk-reduction and treatment of osteoporosis by providing medically accurate information to patients, health professionals and the public. At least 2 million Canadians are affected by osteoporosis. One in four women and many men over the age of 50 have osteoporosis. However, the disease can occur at any age. There are approximately 30,000 hip fractures per year in Canada; data on spinal fractures is limited, but it is estimated that 65 per cent of vertebral fractures go undetected. For more information,

1 Crilly RG et al. Hip fractures in long-term care: is the excess explained by the age and gender distribution of the residents? J Aging Research. Published online 2010 Aug 24. Accessed on August 18, 2015.
2 Papaioannou A et al. J Soc Obstet Gynaecol Can. 2000.
3 Papaioannou A et al. Osteoporosis management among residents living in long-term care.Osteoporos Int. Published on 2009 Sep. Accessed on August 19, 2015.
4 Ioannidis G et al. Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study. CMAJ. Published on 2009 Sep 1. Accessed on August 19, 2015.
5 Wiktorowicz ME et al. Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int. Published in 2001. Accessed on August 19, 2015.
6 Papaioannou A et al. The osteoporosis care gap in Canada. BMC Musculoskeletal Disord. Published 2004 Apr 6. Accessed on August 19, 2015
7 Zarowitz B et al. Osteoporosis prevalence and characteristics of treated and untreated nursing home residents with osteoporosis. JAMDA. Published online 2015 Apr 16. Accessed on August 19, 2015.
8 Kennedy C et al. Osteoporosis prescribing in long-term care: impact of a provincial knowledge translation strategy. Can J Aging. 2015 June. Accessed on August 19, 2015