To Treat or Not To Treat, That Is the Question: Proceedings of the Quebec Symposium for the Treatment of Osteoporosis in Long-Term Care Institutions, Saint-Hyacinthe, Quebec, November 5, 2004

Duque, Gustavo; Mallet, Louise; Roberts, Ayanna; Gingrass, Serge; Kremer, Richard; Sainte-Marie, Louis-Georges; Kiel, Douglas P.

doi:10.1016/j.jamda.2006.05.006

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Volume 7, Issue 7 , Pages 435-441, September 2006

To Treat or Not To Treat, That Is the Question: Proceedings of the Quebec Symposium for the Treatment of Osteoporosis in Long-Term Care Institutions, Saint-Hyacinthe, Quebec, November 5, 2004

Gustavo Duque, MD, PhD
- Division of Geriatric Medicine, McGill University, Montreal, Quebec, Canada
- Centre d’hébergement de Longue Durée, Lachine, Quebec, Canada
- Address correspondence to Gustavo Duque, MD, PhD, Division of Geriatric Medicine, McGill University-Jewish General Hospital, 3755, Cote Sainte Catherine, Montreal, QC, Canada, H3T 1E2.
Louise Mallet, PharmD
- Division of Geriatric Medicine, McGill University, Montreal, Quebec, Canada
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
Ayanna Roberts
- Division of Geriatric Medicine, McGill University, Montreal, Quebec, Canada
Serge Gingrass, MD
- Centre for Bone and Periodontal Research, McGill University, Montreal, Quebec, Canada
Richard Kremer, MD, PhD
- Centre for Bone and Periodontal Research, McGill University, Montreal, Quebec, Canada
Louis-Georges Sainte-Marie, MD
- Division of Endocrinology, University of Montreal, Montreal, Quebec, Canada
Douglas P. Kiel, MD
- Institute for Aging Research, Hebrew SeniorLife and Havard Medical School, Boston, MA.

published online 10 July 2006.

Objectives

Patients in long-term care institutions (LTCI) are especially at risk for osteoporotic fractures owing to their lack of mobility, poor nutrition, and limited sun exposure. Previous reports have shown that osteoporosis is underdiagnosed and undertreated in LTCI despite the high incidence of osteoporotic fractures in these settings. This document has been developed to assist clinicians practicing in LTCI with the diagnosis and treatment of osteoporosis in their institutionalized patients. These proceedings offer an overview of the particular characteristics of patients at LTCI. Management strategies include both nonpharmacological and pharmacological interventions for the prevention and treatment of osteoporotic fractures in very frail older subjects.

Participants

This guide is an edited review of presentations and discussions held by specialists in osteoporosis in the elderly together with physicians and pharmacists practicing in LTCI in the province of Quebec. This symposium was held in Saint-Hyacinthe, Quebec on November 5, 2004.

Values

The value of a given diagnostic test or treatment option was determined based on the clinical experiences and opinions of the participants and a review of the literature from an evidence-based perspective.

Recommendations

All patients located at LTCI are at potential risk for osteoporotic fractures. Global interventions should include vitamin D, calcium, and a comprehensive exercise program. In patients who are at high risk for osteoporotic fractures or with previous fractures, pharmacological treatment should be started.

Validation

These recommendations were approved during the final plenary of the symposium. All the prevailing opinions were summarized and included in this article.

Keywords: Long-term care , osteoporosis , biphosphonates , vitamin D , calcium , fractures