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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.

ABSTRACTBackground Resident perspectives on feedback are key determinants of its acceptance and effectiveness, and provider credibility is a critical element in perspective formation. It is unclear what factors influence a resident's judgments of feedback credibility.Objective We examined how residents perceive the credibility of feedback providers during a formative objective structured clinical examination (OSCE) in 2 ways: (1) ratings of faculty examiners compared with standardized patient (SP) examiners, and (2) ratings of faculty examiners based on alignment of expertise and station content.Methods During a formative OSCE, internal medicine residents were randomized to receive immediate feedback from either faculty examiners or SP examiners on communication stations, and at least 1 specialty congruent and either 1 specialty incongruent or general internist faculty examiner for clinical stations. Residents rated perceived credibility of feedback providers on a 7-point scale. Results were analyzed with proportional odds models for ordinal credibility ratings.Results A total of 192 of 203 residents (95), 72 faculty, and 10 SPs participated. For communication stations, odds of high credibility ratings were significantly lower for SP than for faculty examiners (odds ratio OR  0.28, P < .001). For clinical stations, credibility odds were lower for specialty incongruent faculty (OR  0.19, P < .001) and female faculty (OR  0.45, P < .001).Conclusions Faculty examiners were perceived as being more credible than SP examiners, despite standardizing feedback delivery. Specialty incongruency with station content and female sex was associated with lower credibility ratings for faculty examiners.

Introduction:Osteoporosis and fragility fractures are important public health concerns. Cathepsin K inhibitors, including odanacatib, are a novel class of medications for osteoporosis whose mechanism of action is to directly inhibit bone resorption without killing osteoclasts, thereby permitting the complex coupling between bone resorption and formation to continue.Areas covered:The physiological basis for the mechanism of action of cathepsin K inhibitors is covered in addition to a review of the preclinical, Phase I, Phase II and preliminary Phase III trial data of odanacatib.Expert opinion:Evidence suggests that odanacatib has similar efficacy to bisphosphonates at increasing bone mineral density and decreasing risk of fragility fractures. Although odanacatib may preferentially inhibit bone resorption more than formation, the clinical significance of this difference in mechanism of action is not yet known. A careful analysis of the Phase III trial data is needed with specific attention to adverse events.