A research paper published in the August issue of Canadian Family Physician correctly states that many family physicians are not following the 2002 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada.1 The abstract concludes, “Higher rates of bone mineral density screening and more widespread treatment of osteoporosis could prevent many fractures among these patients.”1
Family physicians in Canada are well aware of the Canadian osteoporosis guidelines and of risk factors for and management of osteoporosis. However, most of us in clinical practice are also aware that bone mineral density studies are not accurate predictors of who will and who will not get fragility fractures.2 The results of bone mineral density studies, therefore, often make little difference to our recommendations to our patients.
The Canadian Osteoporosis Society suggests everyone 65 years of age and older should have bone mineral density testing. This recommendation is clearly a waste of scarce medical resources. As the 2002 consensus document published in the Canadian Medical Association Journal readily discloses, the Canadian Consensus Guidelines were sponsored by funding from the Canadian Dairy Foundation and major drug companies.3
I suggest the reason that most family physicians do not comply with the 2002 Osteoporosis Society of Canada Guidelines is not because of physician ignorance but because of wisdom and a need to adhere to evidence-based, sensible, and sound clinical practice. More recent evidence, for example, suggests that excess calcium increases morbidity in our elderly patients.4
Family physicians need to do what is best for their patients and not what is best for special-interest groups.
References
- 1.Cheng N, Green ME. Osteoporosis screening for men. Are family physicians following the guidelines? Can Fam Physician. 2008;54:1140-1.e1–5. [PMC free article] [PubMed] [Google Scholar]
- 2.Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, et al. BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res. 2003;18(11):1947–54. doi: 10.1359/jbmr.2003.18.11.1947. Erratum in: CMAJ 2003;168(4):400. CMAJ 2003;168(6):676. CMAJ 2003;168(5):544. [DOI] [PubMed] [Google Scholar]
- 3.Brown JP, Josse RG. Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ. 2002;167(10 Suppl):S1–34. [PMC free article] [PubMed] [Google Scholar]
- 4.Bolland MJ, Barber PA, Doughty RN, Mason B, Horne A, Ames R, et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ. 2008;336(7638):262–6. doi: 10.1136/bmj.39440.525752.BE. Epub 2008 Jan 15. [DOI] [PMC free article] [PubMed] [Google Scholar]