GuidelineCPDRecommendations on screening for primaryprevention of fragility fracturesGuylene Theriault MD MEd,Heather Limburg MSc,Scott Klarenbach MD MSc,Donna L.Reynolds MD MSc,John J.Riva DC PhD,Brett D.Thombs PhD,Laure A.Tessier MSc,Roland Grad MDCM MSc,Brenda J.Wilson MBChB MSc;for the Canadian Task Force on Preventive Health Care■Cite as::CMAJ2023May8;195:E639-49.doi:10.1503/cmaj.221219AbstractBackground:Fragility fractures are a(GRADE)approach to determine the cer-(DXA)of the femoral neck,and re-major health concern for older adultstainty of evidence for each outcome andestimate fracture risk by adding theand can result in disability,admission tostrength of recommendations,andBMD T-score into FRAX(conditional rec-hospital and long-term care,andadhered to Appraisal of Guidelines forommendation,low-certainty evidence).reduced quality of life.This CanadianResearch and Evaluation (AGREE),Guide-We recommend against screeningTask Force on Preventive Health Carelines International Network and Guid-females aged 40-64 years and males(task force)guideline providesance for Reporting Involvement ofaged 40 years and older(strong recom-evidence-based recommendations onPatients and the Public(GRIPP-2)report-mendation,very low-certainty evi-screening to prevent fragility fractures ining guidance.dence).These recommendations applycommunity-dwelling individuals agedto community-dwelling individuals who40 years and older who are not currentlyRecommendations:We recommendare not currently on pharmacotherapyon preventive pharmacotherapy.“risk assessment--first”screening forto prevent fragility fractures.prevention of fragility fractures inMethods:We commissioned systematicfemales aged 65 years and older,withInterpretation:Risk assessment-firstreviews on benefits and harms of screen-initial application of the Canadian clin-screening for females aged 65 years anding,predictive accuracy of risk assess-ical Fracture Risk Assessment Toololder facilitates shared decision-makingment tools,patient acceptability and(FRAX)without bone mineral densityand allows patients to consider preven-benefits of treatment.We analyzed treat-(BMD).The FRAX result should be usedtive pharmacotherapy within their indi-ment harms via a rapid overview ofto facilitate shared decision-makingvidual risk context (before BMD).Recom-reviews.We further examined patientabout the possible benefits and harmsmendations against screening males andvalues and preferences via focus groupsof preventive pharmacotherapy.Afteryounger females emphasize the import-and engaged stakeholders at key pointsthis discussion,if preventive pharmaco-ance of good clinical practice,where clin-throughout the project.We used thetherapy is being considered,cliniciansicians are alert to changes in health thatGrading of Recommendations,Assess-should request BMD measurementmay indicate the patient has experiencedment,Development and Evaluationusing dual-energy x-ray absorptiometryor is at higher risk of fragility fracture.Fragili
