To treat or not to treat, that is the question: proceedings of the Quebec Symposium for the Treatment of Osteoporosis in Long-term Care Institutions, Saint-Hyacinthe, Quebec, November 5, 2004.
OBJECTIVE
Patients in long-term care institutions (LTCI) are especially at risk for osteoporotic fractures owing to their lack of mobility, poor nutrition, and limited sun exposure. Previous reports have shown that osteoporosis is underdiagnosed and undertreated in LTCI despite the high incidence of osteoporotic fractures in these settings. This document has been developed to assist clinicians practicing in LTCI with the diagnosis and treatment of osteoporosis in their institutionalized patients. These proceedings offer an overview of the particular characteristics of patients at LTCI. Management strategies include both nonpharmacological and pharmacological interventions for the prevention and treatment of osteoporotic fractures in very frail older subjects.


METHODS
This guide is an edited review of presentations and discussions held by specialists in osteoporosis in the elderly together with physicians and pharmacists practicing in LTCI in the province of Quebec. This symposium was held in Saint-Hyacinthe, Quebec on November 5, 2004.


METHODS
The value of a given diagnostic test or treatment option was determined based on the clinical experiences and opinions of the participants and a review of the literature from an evidence-based perspective.


CONCLUSIONS
All patients located at LTCI are at potential risk for osteoporotic fractures. Global interventions should include vitamin D, calcium, and a comprehensive exercise program. In patients who are at high risk for osteoporotic fractures or with previous fractures, pharmacological treatment should be started.


RESULTS
These recommendations were approved during the final plenary of the symposium. All the prevailing opinions were summarized and included in this article.
Duque
Gustavo
G
Division of Geriatric Medicine, McGill University-Jewish General Hospital, 3755 Côte Sainte Catherine, Montreal, Quebec, Canada. gustavo.duque@mcgill.ca
Mallet
Louise
L
Roberts
Ayanna
A
Gingrass
Serge
S
Kremer
Richard
R
Sainte-Marie
Louis-Georges
LG
Kiel
Douglas P
DP
D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D050723:Fractures, Bone / Q000209:etiology; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D015994:Incidence; D008134:Long-Term Care / Q000379:methods* / Q000592:standards; D008403:Mass Screening; D051346:Mobility Limitation; D009735:Nursing Homes; D009752:Nutritional Status; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D018579:Patient Selection; D011792:Quebec / Q000453:epidemiology; D012307:Risk Factors; D013472:Sunlight; D014807:Vitamin D / Q000627:therapeutic use
D050071:Bone Density Conservation Agents; D014807:Vitamin D; D002118:Calcium