Fracture Prevention in Long Term Care (LTC)

Older adults represent Ontario’s fastest growing population. Those living in Long Term Care (LTC) are at high risk of fragility fractures (broken bones from a fall from standing height or less). Fracture rate for Long Term Care residents is two to four times that of similar-aged adults in the community. Without preventative action, financial and human costs associated with osteoporotic fractures would increase dramatically. As would the risk of re-fracture!

A framework was developed in 2007 to prevent hip and other osteoporotic fractures and improve the lives and bone health of older adults residing in long term care in Ontario. Funded by the Ministry of Health & Long-Term Care, the Ontario Osteoporosis Strategy for LTC (OOS LTC) is part of the broader Ontario Osteoporosis Strategy, and aims at increasing awareness and preventing fractures among older adults residing in long term care.

The OOS LTC provides healthcare professionals, seniors and their families’ access to quality information and resources on osteoporosis prevention & management as well as an implementation framework on the guidelines. The Strategy’s goal is to provide meaningful and useful information and the latest research and best care practices to improve bone health of older adults.

In LTC, fracture prevention initiatives have included development of fracture prevention recommendations specifically for long term care and standardized risk assessment using the Fracture Risk Scale, which will be integrated into the RAI-MDS tool.

Ontario Osteoporosis Strategy would like to thank and acknowledge Dr. Alexandra Papaioannou, a geriatrician with Hamilton Health Sciences and professor, department of medicine at McMaster University in conjunction with a team of researchers and health care providers and Osteoporosis Canada’s Scientific Advisory Council (SAC) for their tremendous work and efforts in developing the 2015 Osteoporosis Long Term Care Recommendations & Guidelines which has helped increase awareness and prevent fractures among frail older adults residing in long term care.

Since 2007, the OOS LTC has engaged in outreach activities in Ontario to increase uptake of evidence-based osteoporosis/fracture prevention strategies in long-term care homes with a focus on:

  • Falls Prevention - preventing unnecessary fractures from falls and handling during care
  • Low-cost Interventions - providing information about the simple low-cost care interventions
  • Knowledge Dissemination - educating health care providers working in LTC about fracture risk and prevention
  • Knowledge Translation - developing awareness-raising resources and clinical tools to support fracture prevention
  • Pain Reduction - reducing the pain and suffering from osteoporosis and fractures
  • Vitamin D & Calcium intake - educating residents, their families and health care professionals working in LTC on the importance of appropriate vitamin D and calcium intake

Fracture Prevention in LTC Toolbox

What we do

The Ontario Osteoporosis Strategy continues to actively develop standardized fracture risk assessment and management tools to prevent fractures among older adults residing in Long Term Care. This includes disseminating and promoting Long Term Care Fracture Prevention Guidelines; enabling Long Term Care staff and professionals to have easy and quick access to LTC clinical tools, resources and accredited online education on osteoporosis care and fracture prevention, thereby being able to provide residents access to best practices in improved fracture prevention screening, treatment and care directly within Long Term Care homes.

User-friendly tool-kits, DVD and many useful PowerPoint resources supporting Long Term Care residents, their families and health professionals can also be found at: Geriatric Education and Research in Aging Sciences (GERAS) Centre.


By developing resident, family education, awareness knowledge tools, the Ontario Osteoporosis Strategy in Long Term Care (OOS LTC) has increased awareness of fracture risk and strategies to reduce fracture risk among LTC residents and their families and has increased access to promotion tools for use by family and resident councils in LTC.

Since the implementation of the Strategy, prescribing patterns in Ontario LTC homes have seen changes. Vitamin D prescribing – in particular – has increased by 40%, which may have an impact on falls and fracture reduction.

With the Fracture Risk Scale (FRS) being launched this year, the OOS LTC continues to work alongside many partners and stakeholders to improve bone health and quality of life among older adults residing in long term care.