title: Too Fit To Fracture: a consensus on future research priorities in osteoporosis and exercise.
abstract: An international consensus process identified the following research priorities in osteoporosis and exercise: study of exercise in high-risk cohorts, evaluation of multimodal interventions, research examining translation into practice and a goal to examine fracture outcomes.
  
  
  BACKGROUND
  To identify future research priorities related to exercise for people with osteoporosis with and without osteoporotic spine fracture via international consensus.
  
  
  METHODS
  An international expert panel and representatives from Osteoporosis Canada led the process and identified opinion leaders or stakeholders to contribute. A focus group of four patient advocates identified quality of life, mobility, activities of daily living, falls, bone mineral density, and harms as outcomes important for decision-making. Seventy-five individuals were invited to participate in an online survey asking respondents to define future research priorities in the area of osteoporosis and exercise; the response rate was 57%. Fifty-five individuals from seven countries were invited to a half-day consensus meeting; 60% of invitees attended. The results of the online survey, knowledge synthesis activities, and results of the focus group were presented. Nominal group technique was used to come to consensus on research priorities.
  
  
  RESULTS
  Research priorities included the study of exercise in high-risk cohorts (e.g., ≥ 65 years, low BMD, moderate/high risk of fracture, history of osteoporotic vertebral fractures, hyperkyphotic posture, functional impairments, or sedentary), the evaluation of multimodal interventions, research examining translation into practice, and a goal to examine fracture outcomes. The standardization of outcomes or protocols that could be evolved into large multicentre trials was discussed.
  
  
  CONCLUSIONS
  The research priorities identified as part of the Too Fit To Fracture initiative can be used to inform the development of multicentre collaborations to evaluate and implement strategies for engaging individuals with osteoporosis in a safe and effective exercise.
authors.affiliation: Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada, lmgiangr@uwaterloo.ca.
authors.forename: L M
authors.initials: LM
authors.lastname: Giangregorio
authors.forename: N J
authors.initials: NJ
authors.lastname: MacIntyre
authors.forename: A
authors.initials: A
authors.lastname: Heinonen
authors.forename: A M
authors.initials: AM
authors.lastname: Cheung
authors.forename: J D
authors.initials: JD
authors.lastname: Wark
authors.forename: K
authors.initials: K
authors.lastname: Shipp
authors.forename: S
authors.initials: S
authors.lastname: McGill
authors.forename: M C
authors.initials: MC
authors.lastname: Ashe
authors.forename: J
authors.initials: J
authors.lastname: Laprade
authors.forename: R
authors.initials: R
authors.lastname: Jain
authors.forename: H
authors.initials: H
authors.lastname: Keller
authors.forename: A
authors.initials: A
authors.lastname: Papaioannou
mesh_terms: D035843:Biomedical Research / Q000379:methods; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods; D017144:Focus Groups; D006801:Humans; D010024:Osteoporosis / Q000503:physiopathology*; D058866:Osteoporotic Fractures / Q000503:physiopathology / Q000517:prevention & control*; D010809:Physical Fitness / Q000502:physiology