Osteoporosis

Discharge Criteria:

1. Patients deemed to have LOW fracture risk can be discharged with the following criteria met:
   1. Stable clinical risk factors for bone loss (not anticipated to change in the next 2-5 years)
2. Patients deemed to have HIGH fracture risk requiring lifelong therapy (not appropriate for drug holiday) can be discharged with the following criteria met:
   1. Tolerating current osteoporosis therapy
   2. Stable BMD after 1-3 years of osteoporosis therapy
   3. No new fractures on current osteoporosis therapy
3. Patients currently on Bisphosphonate DRUG HOLIDAY can be discharged if the following criteria are met:
   1. Completed bisphosphonate therapy for 3-6 years with adequate clinical response
   2. Prior denosumab and transitioned to bisphosphonate therapy for 12 or more months, with stable BMD 
   3. No new fractures (during osteoporosis therapy)
   4. Stable clinical risk factors for bone loss (not anticipated to change in next 2-5 years)
4. Patient with moderate or high risk of fracture and consistently expresses a desire not to start pharmacotherapy

Resources: 

• Letter to primary care provider
• Letter to patient

Topic Expert Review: Lianne Tile, Angela Cheung, Robert Josse, Miranda Boggild (Metabolic Bone Specialists)   

Primary Care review: Dr Curtis Handford, DFCM, St Michael's Hospital 

Plain language review: Katrina Grieve, St Michael's Hospital 

Reference: 

1. Morin et al. Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update. CMAJ October 10, 2023 195 (39) E1333-E1348; DOI: https://doi.org/10.1503/cmaj.221647 

2. Dolores Shoback, Clifford J Rosen, Dennis M Black, Angela M Cheung, M Hassan Murad, Richard Eastell, Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Guideline Update, The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 3, March 2020, Pages 587–594, https://doi.org/10.1210/clinem/dgaa048