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Le risque de fracture augmente avec l'age, en raison du declin de la robustesse squelettique et de l'augmentation du risque de chute. Au Canada, plus de 2 millions de personnes [...], Contexte: Au Canada, plus de 2 millions de personnes vivent avec l'osteoporose, une maladie qui accroTt le risque de fracture, ce qui fait augmenter la morbidite et la mortalite, et entraTne une perte de qualite de vie et d'autonomie. La presente actualisation des lignes directrices vise a accompagner les professionnelles et professionnels de la sante au Canada dans la prestation de soins visant a optimiser la sante osseuse et a prevenir les fractures chez les femmes menopausees et les hommes de 50 ans et plus. Methodes: Le present document fournit une actualisation des lignes directrices de pratique clinique de 2010 d'Osteoporose Canada sur le diagnostic et la prise en charge de l'osteoporose au pays. Nous avons utilise l'approche GRADE (Grading of Recommendations Assessment, Development and Evaluation) et effectue l'assurance de la qualite conformement aux normes de qualite et de presentation des rapports de la grille AGREE II (Appraisal of Guidelines for Research & Evaluation). Les medecins de premier recours et les patientes et patients partenaires ont ete representes a tous les niveaux des comites et des groupes ayant participe a l'elaboration des lignes directrices, et ont participe a toutes les etapes du processus pour garantir la pertinence des informations pour les futurs utilisateurs et utilisatrices. Le processus de gestion des interets concurrents a ete entame avant l'elaboration des lignes directrices et s'est poursuivi sur toute sa duree, selon les principes du Reseau international en matiere de lignes directrices. Dans la formulation des recommandations, nous avons tenu compte des avantages et des risques, des valeurs et preferences de la patientele, des ressources, de l'equite, de l'acceptabilite et de la faisabilite; la force de chacune des recommandations a ete determinee en fonction du cadre GRADE. Recommandations: Les 25 recommandations et les 10 enonces de bonne pratique sont repartis en sections: activite physique, alimentation, evaluation du risque de fracture, instauration du traitement, interventions pharmacologiques, duree et sequence du traitement, et monitorage. La prise en charge de l'osteoporose devrait se fonder sur le risque de fracture, etabli au moyen d'une evaluation clinique realisee avec un outil d'evaluation du risque de fracture valide. L'activite physique, l'alimentation et la pharmacotherapie sont des elements essentiels a la strategie de prevention des fractures, qui devraient etre personnalises. Interpretation: Les presentes lignes directrices ont pour but d'outiller les professionnelles et professionnels de la sante et la patientele afin qu'ensemble ils puissent parler de l'importance de la sante osseuse et du risque de fracture tout au long de la vie adulte avancee. La detection et la prise en charge efficace de la fragilite osseuse peuvent contribuer a reduire les fractures et a preserver la mobilite, l'autonomie et la qualite de vie.

Fracture risk increases with advancing age, as a result of declining skeletal strength and increased risk of falling. In Canada, more than 2 million people live with osteoporosis. (1) Every [...], Background: In Canada, more than 2 million people live with osteoporosis, a disease that increases the risk for fractures, which result in excess mortality and morbidity, decreased quality of life and loss of autonomy. This guideline update is intended to assist Canadian health care professionals in the delivery of care to optimize skeletal health and prevent fractures in postmenopausal females and in males aged 50 years and older. Methods: This guideline is an update of the 2010 Osteoporosis Canada clinical practice guideline on the diagnosis and management of osteoporosis in Canada. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and quality assurance as per Appraisal of Guidelines for Research and Evaluation (AGREE II) quality and reporting standards. Primary care physicians and patient partners were represented at all levels of the guideline committees and groups, and participated throughout the entire process to ensure relevance to target users. The process for managing competing interests was developed before and continued throughout the guideline development, informed by the Guideline International Network principles. We considered benefits and harms, patient values and preferences, resources, equity, acceptability and feasibility when developing recommendations; the strength of each recommendation was assigned according to the GRADE framework. Recommendations: The 25 recommendations and 10 good practice statements are grouped under the sections of exercise, nutrition, fracture risk assessment and treatment initiation, pharmacologic interventions, duration and sequence of therapy, and monitoring. The management of osteoporosis should be guided by the patient's risk of fracture, based on clinical assessment and using a validated fracture risk assessment tool. Exercise, nutrition and pharmacotherapy are key elements of the management strategy for fracture prevention and should be individualized. Interpretation: The aim of this guideline is to empower health care professionals and patients to have meaningful discussions on the importance of skeletal health and fracture risk throughout older adulthood. Identification and appropriate management of skeletal fragility can reduce fractures, and preserve mobility, autonomy and quality of life.

Introduction Exercise is recommended for fall and fracture prevention. (1,2) Progressive resistance training (PRT) has the potential to be osteogenic, but concerns about safety in people with osteoporosis limit its [...], Objective. The purpose of this trial is to evaluate the effect of twice-weekly, moderate-to-high intensity progressive resistance training (PRT) for 1 year on lumbar spine bone mineral density (BMD) in individuals with low BMD, compared to attention control. Secondary analyses will examine if resistance training improves other health outcomes; if high intensity is more effective than moderate intensity resistance training for all outcomes; the cost of intervention versus benefit; the willingness to pay; and harms. Methods. For this study, 324 men or postmenopausal women aged >50 years with a femoral neck, total hip, or lumbar spine BMD T-score of [less than or equal to] -1, or a Fracture Risk Assessment Tool probability of >20% for major osteoporotic fracture or [greater than or equal to]3% for hip fracture are being recruited to participate in a randomized controlled trial with 1:1:1 randomization. Participants will be stratified by site (3 centers) to twice-weekly, supervised PRT at moderate intensity (about 10 repetitions maximum), to high intensity PRT ([less than or equal to]6 repetitions maximum), or to a home posture and balance exercise program (attention control) for 1 year (resistance training to comparator allocation ratio of 2:1). The primary outcome is lumbar spine BMD via dual-energy X-ray absorptiometry. Secondary outcomes include trabecular bone score, proximal femur and total hip BMD and structure, bone-free and appendicular lean mass, physical functioning, falls, fractures, glucose metabolism, cost per life-year gained, adverse events, and quality of life. Between-group differences will be tested in intention-to-treat and per-protocol analyses using analysis of covariance, chi-square tests, or negative binomial or logistic regression, adjusting for site and baseline values. Impact. The Finding the Optimal Resistance Training Intensity For Your Bones trial will support decision making on resistance training for people at risk of fracture. Keywords: Bone Mineral Density, Fracture, Intensity, Moderate, Osteoporosis, Progressive Resistance Training

A successful public health response to the COVID-19 pandemic requires accurate and timely identification of, and support for, high-risk groups. There is increasing recognition that marginalized groups, including congregate care [...], Background: Disability-related considerations have largely been absent from the COVID-19 response, despite evidence that people with disabilities are at elevated risk for acquiring COVID-19. We evaluated clinical outcomes in- patients who were admitted to hospital with COVID-19 with a disability compared with patients without a disability. Methods: We conducted a retrospective cohort study that included adults with COVID-19 who were admitted to hospital and discharged between Jan. 1, 2020, and Nov. 30, 2020, at 7 hospitals in Ontario, Canada. We compared in-hospital death, admission to the intensive care unit (ICU), hospital length of stay and unplanned 30-day readmission among patients with and without a physical disability, hearing or vision impairment, traumatic brain injury, or intellectual or developmental disability, overall and stratified by age ([less than or equal to] 64 and [greater than or equal to] 65 yr) using multivariable regression, controlling for sex, residence in a long-term care facility and comorbidity. Results: Among 1279 admissions to hospital for COVID-19, 22.3% had a disability. We found that patients with a disability were more likely to die than those without a disability (28.1% v. 17.6%), had longer hospital stays (median 13.9 v. 7.8 d) and more readmissions (17.6% v. 7.9%), but had lower ICU admission rates (22.5% v. 28.3%). After adjustment, there were no statistically significant differences between those with and without disabilities for in-hospital death or admission to ICU. After adjustment, patients with a disability had longer hospital stays (rate ratio 1.36, 95% confidence interval [CI] 1.19-1.56) and greater risk of readmission (relative risk 1.77, 95% CI 1.14-2.75). In age-stratified analyses, we observed longer hospital stays among patients with a disability than in those without, in both younger and older subgroups; readmission risk was driven by younger patients with a disability. Interpretation: Patients with a disability who were admitted to hospital with COVID-19 had longer stays and elevated readmission risk than those without disabilities. Disability-related needs should be addressed to support these patients in hospital and after discharge.

Des etudes internationales ont rapporte que les patients hospitalises en raison de la maladie a coronavirus 2019 (COVID-19) presentaient des taux eleves de maladie grave et de mortalite (1-5). Deux [...], CONTEXTE: Les caracteristiques des patients, les soins cliniques, l'utilisation des ressources et les issues cliniques des personnes atteintes de la maladie a coronavirus 2019 (COVID-19) hospitalisees au Canada ne sont pas bien connus. METHODES: Nous avons recueilli des donnees sur tous les adultes hospitalises atteints de la COVID-19 ou de l'influenza ayant obtenu leur conge d'unites medicales ou d'unites de soins intensifs medicaux et chirurgicaux entre le 1er novembre 2019 et le 30 juin 2020 dans 7 centres hospitaliers de Toronto et de Mississauga (Ontario). Nous avons compare les issues cliniques des patients a l'aide de modeles de regression multivariee, en tenant compte des facteurs sociodemographiques et de l'intensite des comorbidites. Nous avons valide le degre d'exactitude de 7 scores de risque mis au point a l'externe pour determiner leur capacite a predire le risque de deces chez les patients atteints de la COVID-19. RESULTATS: Parmi les hospitalisations retenues, 1027 patients etaient atteints de la COVID-19 (age median de 65 ans, 59,1% d'hommes) et 783 etaient atteints de l'influenza (age median de 68 ans, 50,8% d'hommes). Les patients ages de moins de 50 ans comptaient pour 21,2% de toutes les hospitalisations dues a la COVID-19 et 24,0% des sejours aux soins intensifs. Com pa rativement aux patients atteints de l'influenza, les patients atteints de la COVID-19 presentaient un taux de mortalite perhospitaliere (mortalite non ajustee 19,9% c. 6,1%; risque relatif [RR] ajuste 3,46%, intervalle de confiance [IC] a 95% 2,56-4,68) et un taux d'utilisation des ressources des unites de soins intensifs (taux non ajuste 26,4% c. 18,0%; RR ajuste 1,50, IC a 95% 1,25-1,80) significativemen t plus eleves, ainsi qu'une duree d'hospitalisation (duree mediane non ajustee 8,7 jours c. 4,8 jours; rapport des taux d'incidence ajuste 1,45; IC a 95% 1,25-1,69) significativement plus longue. Le taux de rehospitalisation dans les 30 jours n'etait pas significativement different (taux non ajuste 9,3% c. 9,6%; RR ajuste 0,98%, IC a 95% 0,70-1,39). Trois scores de risque utilisant un pointage pour predire la mortalite perhospitaliere ont montre une bonne discrimination (aire sous la courbe [ASC] de la fonction d'efficacite du recepteur [ROC] 0,72-0,81) et une bonne calibration. INTERPRETATION: Durant la premiere vague de la pandemie, l'hospitalisation des patients atteints de la COVID-19 etait associee a des taux de mortalite et d'utilisation des ressources des unites de soins intensifs et a une duree d'hospitalisation significativement plus importants que les hospitalisations des patients atteints de l'influenza. De simples scores de risque peuvent predire avec une bonne exactitude le risque de mortalite perhospitaliere des patients atteints de la COVID-19.

International studies report that patients admitted to hospital with coronavirus disease 2019 (COVID-19) have high rates of critical illness and mortality. (1-5) Two small Canadian case series have described care [...], BACKGROUND: Patient characteristics, clinical care, resource use and outcomes associated with admission to hospital for coronavirus disease 2019 (COVID-19) in Canada are not well described. METHODS: We described all adults with COVID-19 or influenza discharged from inpatient medical services and medical-surgical intensive care units (ICUs) between Nov. 1, 2019, and June 30, 2020, at 7 hospitals in Toronto and Mississauga, Ontario. We compared patient outcomes using multivariable regression models, controlling for patient sociodemographic factors and comorbidity level. We validated the accuracy of 7 externally developed risk scores to predict mortality among patients with COVID-19. RESULTS: There were 1027 hospital admissions with COVID-19 (median age 65 yr, 59.1% male) and 783 with influenza (median age 68 yr, 50.8% male). Patients younger than 50 years accounted for 21.2% of all admissions for COVID-19 and 24.0% of ICU admissions. Compared with influenza, patients with COVID-19 had significantly greater in-hospital mortality (unadjusted 19.9% v. 6.1%, adjusted relative risk [RR] 3.46, 95% confidence interval [CI] 2.56-4.68), ICU use (unadjusted 26.4% v. 18.0%, adjusted RR 1.50, 95% CI 1.25-1.80) and hospital length of stay (unadjusted median 8.7 d v. 4.8 d, adjusted rate ratio 1.45, 95% CI 1.25-1.69). Thirty-day readmission was not significantly different (unadjusted 9.3% v. 9.6%, adjusted RR 0.98, 95% CI 0.70-1.39). Three points-based risk scores for predicting in-hospital mortality showed good discrimination (area under the receiver operating characteristic curve [AUC] ranging from 0.72 to 0.81) and calibration. INTERPRETATION: During the first wave of the pandemic, admission to hospital for COVID-19 was associated with significantly greater mortality, ICU use and hospital length of stay than influenza. Simple risk scores can predict in-hospital mortality in patients with COVID-19 with good accuracy.

Osteoporotic vertebral fractures are associated with significant health and economic burden worldwide (1,2) and can lead to functional decline, (3) pain, (4) reduced quality of life, (5) hospitalization, (6) and [...], Background. Regular exercise is advocated in osteoporosis guidelines to prevent fractures. Few studies have evaluated the effect of exercise on functional performance, posture, and other outcomes that are important to patients after vertebral fractures. Objective. This pilot study will explore the effect of home exercise versus control on functional performance, posture, and patient-reported outcome measures. Design. This study was a parallel 2-arm pilot feasibility trial with 1:1 randomization to exercise or attentional control groups. Setting. This study took place in 5 Canadian and 2 Australian academic or community hospitals/centers. Participants. This study included 141 women [greater than or equal to]65 years of age with radiographically confirmed vertebral fractures. Intervention. A physical therapist delivered exercise and behavioral counseling in 6 home visits over 8 months and monthly calls. Participants were to exercise [greater than or equal to]3 times weekly. Controls received equal attention. Measurements. Functional performance, posture, quality of life, pain, and behavior-change outcomes were assessed at baseline and after 6 (questionnaires only) and 12 months. Adherence to exercise was assessed by calendar diary. All t tests examined between-group mean differences (MD) in change from baseline in intention-to-treat and per-protocol analyses. Results. There was a small effect of exercise on 5 times sit-to-stand test versus control (MD = -1.58 [95% CI = -3.09 to -0.07], intention-to-treat; MD = -1.49 [95% CI = -3.12 to 0.16], per-protocol). There were no other major or statistically significant MDs for any other measured outcomes after follow-up. Adherence declined over time. Limitations. Treatment effects on variables may have been underestimated due to multiple comparisons and underpowered analyses. Conclusions. Our exploratory estimate of the effect of exercise on functional leg muscle strength was consistent in direction and magnitude with other trials in individuals with vertebral fractures. Declining adherence to home exercise suggests that strategies to enhance long-term adherence might be important in future confirmatory trials.