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Recommendations for preventing fracture in long-term care

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Alexandra Papaioannou MD MSc, Nancy Santesso RD PhD, Suzanne N. Morin MD MSc, Sidney Feldman MD, Jonathan D. Adachi MD, Richard Crilly BSc MD, Lora M. Giangregorio PhD, Susan Jaglal PhD, Robert G. Josse MBBS, Sharon Kaasalainen PhD, Paul Katz MD, Andrea Moser MD MSc, Laura Pickard MA, Hope Weiler RD PhD, Susan Whiting PhD, Carly J. Skidmore MSc, Angela M. Cheung MD PhD; for the Scientific Advisory Council of Osteoporosis Canada

Key Points: 

  • In older adults living in long-term care (residents), fractures cause pain, agitation, immobility and transfers to hospital.
  • Residents identified as being at high risk of fracture include those with prior fracture of the hip or spine, those with more than one prior fracture and those with one prior fracture and recent use of glucocorticoids.
  • Recommendations for preventing fracture in long-term care were developed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, with consideration of the quality of the available evidence, the balance between benefits and harms, the preferences of residents and their care providers, and the resources required to implement the recommendations.
  • Strategies to prevent fractures, including vitamin D and calcium supplementation, use of hip protectors, exercise, multifactorial interventions to prevent falls and pharmacologic therapies, should be tailored to each resident’s level of fracture risk, mobility, life expectancy, renal function and ability to swallow.