Seeking clarification of osteoporosis guidelines

The recent statement of the Canadian Task Force on Preventive Health Care regarding prevention of osteoporosis and osteoporotic fractures in postmenopausal women1 contains some confusing information. One example is the statement that “Although there is no direct evidence that screening reduces fractures, there is good evidence that screening is effective in identifying postmenopausal women with low bone mineral density and that treating osteoporosis can reduce the risk of fractures in this population.” This wording appears to have been chosen to obfuscate the meaning, since low bone mineral density, particularly in the younger population, does not strongly correlate with fracture risk or osteoporosis.2^,3

Other parts of the recommendation statement do not appear particularly practical. For example, the algorithm shown in Fig. 1 of the article1 suggests that all women 65 years of age or older should undergo repeat dual-energy x-ray absorptiometry (DEXA) every 1 to 2 years, regardless of the result of initial DEXA (even if that result is normal). Admittedly, this agrees with the guidelines of the US Preventive Services Task Force4 and the Osteoporosis Society of Canada,2 but what does it mean for those of us providing primary care? Should we in fact send all of our female patients over age 65, including those in rest homes, for DEXA screening? Would it not be adequate to suggest to women in this age group that they try to exercise regularly and take adequate amounts of vitamin D and calcium?

Also of great concern are the potential medicolegal implications if clinicians do not follow guidelines developed by authoritative bodies such as the Task Force.

Do the CMAJ editors accept guidelines and protocols produced by distinguished Canadian associations (often sponsored by drug companies) without the benefit of peer review or editing?

John Sehmer Clinical Assistant Professor University of British Columbia Vancouver, BC