Treatment Guideline Chart
Osteoporosis is a progressive, systemic skeletal disease characterized by decreased bone mass and micro-architectural deterioration of bone tissue leading to increased bone fragility and susceptibility to fractures.
The more risk factors (eg history of fracture, advanced age, comorbidities, etc) that are present, the greater the risk of fracture.

Osteoporosis Patient Education

Lifestyle Modification

  • Educate all patients on how to reduce the risk of fragility fractures and encourage adherence to drug treatment 


  • Regular weight-bearing exercises and muscle strengthening exercises can improve agility, strength, posture and balance, which may help to prevent falls
    • Jogging, brisk walking, tai chi, weight training
    • Type of exercise will depend on age of patient and physical ability
    • At least 30 minutes of regular exercise 3-4x/week is recommended
  • May modestly increase bone density (for as long as exercise is being done)
  • Physiotherapist-guided exercise is recommended for pain reduction and improvement of daily function in patients with painful vertebral fractures

Avoid Cigarette Smoking and Excessive Alcohol Consumption 

  • Both are associated with increased risk of osteoporotic fractures and should be avoided
  • Alcohol intake may be limited to <2 units/day

Limit Caffeine Intake 

  • High caffeine intake (>330 mg/day) increases risk of fragility fracture
  • Caffeinated drinks should be limited to <1-2 servings/day (240-360 mL/serving)
  • Patients who regularly consume caffeinated drinks should increase their calcium intake (ie 40 mg Calcium for every 177.5 mL cup of coffee)

Fall Prevention

  • Individuals with a history of falls should be assessed for fall risk and advised to undergo a DXA scan 
  • Counsel the patient, especially the elderly and those with a history of falls, on ways to reduce risk of falls
    • Implement measures to prevent falls (eg installing grab bars/handrails, nonslip flooring, adequate lighting, removing loose wires, keeping things within reach)
    • Hip protectors may help reduce the impact on the hip during the fall
  • Evaluate for certain medications (eg sedatives, hypnotics, narcotic analgesics, antihypertensives), neurologic conditions, alcohol use, poor vision and hearing, frailty and deconditioning as these may lead to falls
  • Recommend exercise and physical therapy referral
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