title: 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.
abstract: 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.
authors.affiliation: Division of Geriatric Medicine, McGill University, Montreal, Quebec, Canada. gustavo.duque@mcgill.ca <gustavo.duque@mcgill.ca>
authors.forename: Gustavo
authors.initials: G
authors.lastname: Duque
authors.forename: Louise
authors.initials: L
authors.lastname: Mallet
authors.forename: Ayanna
authors.initials: A
authors.lastname: Roberts
authors.forename: Serge
authors.initials: S
authors.lastname: Gingrass
authors.forename: Richard
authors.initials: R
authors.lastname: Kremer
authors.forename: Louis-Georges
authors.initials: LG
authors.lastname: Sainte-Marie
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Kiel
mesh_terms: D015502:Absorptiometry, Photon; D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002136:Calcium, Dietary / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D019587:Dietary Supplements; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology / Q000517:prevention & control; D006707:Homes for the Aged; D006801:Humans; D007902:Length of Stay; D008134:Long-Term Care / Q000191:economics / Q000379:methods*; D008297:Male; D009735:Nursing Homes; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D010349:Patient Compliance; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011792:Quebec; D012307:Risk Factors; D014807:Vitamin D / Q000008:administration & dosage
chemical_list: D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D004164:Diphosphonates; D014807:Vitamin D