Practice Guidelines for Bone Health and Osteoporosis
Posted:
2023-10-26
What’s happening?
The Osteoporosis Canada 2023 Guideline Update Group recently completed a review and evaluation of published studies using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) to update its 2010 osteoporosis guidelines (1). The PEN Team reviewed the guidelines against recently updated PEN related content to ensure that dietitians are practicing with the most up-to-date information.
Review and comparison
The updated Canadian guidelines are intended to help primary health care professionals in screening community-dwelling postmenopausal females and males (aged 50 years and older) for risk factors for osteoporosis and fractures, and interventions to optimize bone health and prevent fractures (1). Recommendations are also provided for the treatment of individuals with primary osteoporosis.
The authors of the guidelines noted that the strength of the evidence for the recommendations was varied. Of the 25 recommendations and 10 “good practice” statements provided in the guidelines, three recommendations and one practice statement focus on the area of nutrition. The remainder is under the sections of exercise, fracture risk assessment and treatment initiation, pharmacologic interventions, duration and sequence of therapy, and monitoring.
The nutrition section results include (1):
- Conditional recommendations for bone health and fracture prevention:
- “For people who meet the recommended dietary allowance for calcium with a variety of calcium-rich foods, we suggest no supplementation to prevent fractures” (moderate-to-high certainty evidence).
- “We suggest following Health Canada’s recommendation on vitamin D for bone health” (high certainty evidence). Note: Health Canada recommends a vitamin D supplement (400 IU/day) for adults over 50 years of age, in addition to consuming vitamin D-rich foods.
- “For people who follow Canada’s Food Guide (food-guide.canada.ca), we suggest no supplementation of protein, vitamin K or magnesium to prevent fractures” (very low certainty evidence).
- Good practice statement: “For people initiating pharmacotherapy, it is good practice to individualize intake of calcium and vitamin D. Although participants in most pharmacotherapy trials received a minimum of 400 IU/d of vitamin D and up to 1000 mg/d of calcium supplements, food sources or supplementation should be individualized according to risk factors for insufficiency”.
PEN System content on bone health and osteoporosis is in alignment with these guidelines and provides additional recent information beyond that of the guidelines that would be helpful to the dietetic practitioner. Topics include:
- dietary patterns (e.g. Mediterranean style-diet, vegan or vegetarian diet, lower carbohydrate/higher protein diet)
- food/beverages (e.g. alcohol, carbonated beverages, tea and coffee)
- individual nutrients (e.g. silicon, pre-, pro- or synbiotics, nutraceuticals).
Additional Content
Bottom line
Dietitians play an important role in supporting bone growth and maintenance of their clients. Healthy bones are essential for optimal health and mobility for people across the globe (2,3). Calcium is the predominant mineral in bone (2). It is essential for healthy bone growth and maintenance. Vitamin D aids calcium absorption, increases bone mineral density and helps to reduce the risk of fracture (2).
There are a number of risk factors that may increase the risk of poor bone health, many of which are preventable (2,3). The treatment and management of osteoporosis includes behaviour modification of lifestyle factors, including diet and physical activity, as well as other medical and pharmacological
therapies (1,3).
Other country guidelines include:
Camacho PM, Petak SM, Binkley N, Diab DL, Eldeiry LS, Farooki A, et al. American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines For The Diagnosis And Treatment Of Postmenopausal Osteoporosis-2020 Update. Endocr Pract. 2020 May;26(Suppl 1):1-46. doi: 10.4158/GL-2020-0524SUPPL. Abstract available from:
https://pubmed.ncbi.nlm.nih.gov/32427503/References
- Morin SN, Feldman S, Funnell L, Giangregorio L, Kim S, McDonald-Blumer H, et al. Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update. CMAJ. 2023 Oct 10;195(39):E1333-E1348. doi: 10.1503/cmaj.221647. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/37816527/
- Office of the Surgeon General (US). Bone health and osteoporosis: a report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US); 2004. 6, Determinants of Bone Health. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45503/
- Bolster MB. Osteoporosis. Merck Manual Professional Version. 2023 Sep. Available from: https://www.merckmanuals.com/en-ca/professional/musculoskeletal-and-connective-tissue-disorders/osteoporosis/osteoporosis