Approach to osteoporosis diagnosis and fracture risk management in primary care

Guidelines recommend prioritizing fracture risk screening in females 65 years or older with risk factor assessment and FRAX application. Evaluation should include assessment of fall risk and signs of undiagnosed vertebral fractures. Risk assessment and shared decision making should guide further evaluation with BMD testing. Osteoporosis Canada suggests targeting screening as per fracture risk in postmenopausal females 65 years or younger and males 50 years or older, noting limited supporting evidence. Adults 50 years or older should engage in balance, functional, and resistance training twice weekly, and follow Health Canada's recommendations for calcium and vitamin D intake, including a vitamin D supplement of 400 IU daily. Pharmacologic therapy is recommended for those with prior hip or vertebral fracture, 2 or more osteoporotic fractures, a 10-year fracture risk 20% or higher, or a T-score -2.5 or less and age 70 years or older, guided by patient values and preference.