1. 2010 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada
Papaioannou A, et al. CMAJ 2010 Oct 12. [Epub ahead of print].

2. Introduction and Key Changes to the Guidelines
Section One

3. Development of the Guidelines
Key stakeholders were surveyed to identify priorities
Systematic literature reviews were conducted in two key areas
Fracture risk assessment
Therapies for osteoporosis
Graded recommendations were developed based on these reviews 
Speaker notes
Key stakeholders were surveyed to identify priorities for these guidelines. Based on these priorities, systematic reviews of the literature were conducted to update our knowledge in two key areas: 1) fracture risk assessment and 2) therapies for osteoporosis.
Additional topics included were identified by experts and primary care clinicians as important for the management of osteoporosis. Topics were assigned to working groups who performed systematic reviews of the literature. Recommendations were developed based on these reviews.
Each study was assigned a level of evidence using criteria consistent with those used in previous osteoporosis guidelines. Clinical practice recommendations were developed based on the best available evidence and each recommendation was graded using the approach used in previous osteoporosis guidelines.
Reference
Papaioannou A, Leslie WD, Morin S, et al Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada. CMAJ 2010 Oct 12. [Epub ahead of print].
Papaioannou A, et al. CMAJ 2010 Oct 12. [Epub ahead of print].

4. Target Population Women and men > 50 years of age
Other fracture-risk groups are beyond the scope of these guidelines
Speaker notes
The target population of these guidelines is women and men 50 years and older; consequently the systematic reviews focused on this population. Although we acknowledge the importance of other populations with elevated risks for fracture (for example, individuals with chronic kidney disease), in-depth reviews of these conditions were beyond the scope of these guidelines.
Reference
Papaioannou A, Leslie WD, Morin S, et al Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada. CMAJ 2010 Oct 12. [Epub ahead of print].
Papaioannou A, et al. CMAJ 2010 Oct 12. [Epub ahead of print].

5. Key Changes from 20021 to 20102: Fracture Risk Assessment
10-year fracture risk prediction tools incorporate clinical risk factors beyond BMD for improved clinical decision making:
CAROC: Joint initiative of the Canadian Association of Radiologists and Osteoporosis Canada3 OR
FRAX: Fracture Risk Assessment Tool developed by the World Health Organization4
Speaker notes
Since the 2002 Osteoporosis Canada guidelines,1 the importance of using multiple risk factors to predict quantitative (absolute) fracture risk has been recognized. Bone density T-scores are difficult for many patients to understand, while absolute 10-year fracture risk is preferred by physicians and may contribute to a more meaningful patient–physician dialogue over the risks and benefits of treatment.2 Accordingly, in 2005, Osteoporosis Canada adopted 10-year absolute fracture-risk assessment as the preferred method for risk assessment and bone mineral density (BMD) reporting in women and men age 50 and older.3
Since then, there have been several tools introduced that can be used to determine 10-year fracture risk. The 2010 recommendations4 consider only those systems that have been directly tested and validated in the Canadian population. The two validated tools are CAROC3 and FRAX.5
References
1. Brown JP, Josse RG clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 2002; 167(10 Suppl):S1-34.
2. Leslie WD. Absolute fracture risk reporting in clinical practice: a physician-centered survey. Osteoporos Int 2008; 19(4):
3. Siminoski K, Leslie WD, Frame H, et al. Recommendations for bone mineral density reporting in Canada. Can Assoc Radiol J 2005; 56(3):
4. Leslie WD, Berger C, Langsetmo L, et al. Construction and validation of a simplified fracture risk assessment tool for Canadian women and men: results from the CaMos and Manitoba BMD cohorts. Osteoporos Int. In press.
5. Leslie WD, Lix LM, Langsetmo L, et al. Construction of a FRAX® model for the assessment of fracture probability in Canada and implications for treatment. Osteoporos Int. In press.
1. Brown JP, Josse RG. CMAJ 2002; 167(10 Suppl):S1-34.
2. Papaioannou A, et al. CMAJ 2010 Oct 12. [Epub ahead of print]..
3. Leslie WD, Berger C, Langsetmo L, et al. Osteoporos Int. In press.
4. Leslie WD, Lix LM, Langsetmo L, et al. Osteoporos Int. In press.

6. Key Changes from to 20102
Increased focus on the clinical impact of fragility fractures
Increased focus on the care gap that exists in the identification and treatment of high-risk individuals
Speaker notes
The most serious manifestation of osteoporosis is a fragility fracture, defined as a fracture occurring spontaneously or following minor trauma such as a fall from standing height or less.1,2 Compared to 2002,3 the 2010 guidelines include additional emphasis on these fractures and the care gap that exists among people who have sustained such a fracture.4
References
1. Kanis JA, Oden A, Johnell O, et al. The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 2001; 12(5):
2. Bessette L, Ste-Marie LG, Jean S, et al. The care gap in diagnosis and treatment of women with a fragility fracture. Osteoporos Int 2008; 19:79-86.
3. Brown JP, Josse RG clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 2002; 167(10 Suppl):S1-34.
4. Papaioannou A, Leslie WD, Morin S, et al Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada. CMAJ 2010 Oct 12. [Epub ahead of print].
1. Brown JP, Josse RG. CMAJ 2002; 167(10 Suppl):S1-34.
2. Papaioannou A, et al. CMAJ 2010 Oct 12. [Epub ahead of print].

7. Key Changes from 20021 to 20102 (cont’d)
Higher daily vitamin D supplementation (D3)3
400 – 1000 IU for individuals < 50 years
800 – 2000 IU for individuals > 50 years
Lower daily calcium intake (from all sources): 1200 mg
Updated evidence-based approach to therapies
Speaker notes
The 2010 guidelines1 incorporate the recent Osteoporosis Canada review and guideline statement on vitamin D,2 which is a significant change from the 2002 recommendations.3 The 2010 guidelines also include a revised statement regarding calcium intake and an updated evidence-based approach to therapies.
References
1. Papaioannou A, Leslie WD, Morin S, et al Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada. CMAJ 2010 Oct 12. [Epub ahead of print].
2. Hanley DA, Cranney A, Jones G, et al. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada. CMAJ 2010; 182: E610-E618.
3. Brown JP, Josse RG clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 2002; 167(10 Suppl):S1-34.
1. Brown JP, Josse RG. CMAJ 2002; 167(10 Suppl):S1-34.
2. Papaioannou A, et al. CMAJ 2010 Oct 12. [Epub ahead of print].
3. Hanley DA, et al. CMAJ 2010; 182: E610-E618.