Osteoporosis and fractures among people aged 65 and over: recommendations for an integrated framework for action in Quebec
Record ID 32002000002
The objective of this study is to summarize the various reports published worldwide on osteoporosis screening, in order to 1) describe the recommendations and supporting arguments; 2) understand the differences between the recommendations in order to prepare a coherent summary; 3) make recommendations for an integrated framework for action against osteoporosis and fragility fractures in Quebec.
Authors' recommendations: It is difficult to summarize the recommendations on osteoporosis screening and the prevention of fragility fractures, as they are indistinguishably based on two models: one favours clinical management and the second, a public-health-type prevention approach. As a means of preventing fragility fractures, the two models are not incompatible; however, the reports do not clearly demonstrate their complementarity. This is partly due to the fragmentation of disciplines and the fact that prevention and treatment objectives are not clearly defined. Based on the evidence, none of the 11 reports studied recommends universal bone density screening, i.e. among individuals who present no symptoms of osteoporosis and do not request the test. They also do not recommend bone densitometry for risk-free patients seeking medical attention, whether or not they request the test. In spite of these recommendations against intervention, no alternative strategies are put forward for the general public. One aspect that is sometimes alluded to is population-wide screening for risk factors associated with fragility fractures. The reports studied differ on the use of bone densitometry to screen people who, when consulting, present one or more risk factors for osteoporosis or fragility fractures. Although several of the reports agree that the practice could be recommended, they differ on the number and definition of the risk factors. None of the organizations used the prevalence of risk factors among their local populations as a basis for their recommendations. They seem to focus more on the clinicians need to face the growing demand. All the recommendations present osteoporosis as a major health-care issue. The research conducted has focused primarily on imagery techniques and pharmacology, rather than on integrated strategies to fight osteoporosis and fragility fractures, even though there is no direct evidence that these techniques are effective. Although it is virtually not addressed in the reports studied, the imbalance in part caused by the differences in funding capabilities sometimes reduces the scope of thought on the fight against fragility fractures to the single question of bone densitometry or hormone replacement therapy.
Authors' methods: Review
Project Status: Completed
Year Published: 2001
URL for published report: http://www.aetmis.gouv.qc.ca/site/download.php?f=2aeb28767c68d69385318e255ca99e63
English language abstract: An English language summary is available
Publication Type: Not Assigned
- Delivery of Health Care, Integrated
- Mass Screening
- Fractures, Bone
Organisation Name: Agence d'évaluation des technologies et des modes d'intervention en santé
Contact Address: 2021, avenue Union, Bureau 10.083,Montreal, Quebec H3A S29, Canada.Tel: +1 514 873 2563; Fax: +1 514 873 1369
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Copyright: Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS)
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