Northern Health BC Fracture Risk Assessment Project

This project aims to improve bone health and reduce the risk of serious fractures for people living in northern British Columbia, with an initial focus on First Nations communities and patients receiving rheumatology care. This is a population at high risk of osteoporotic fracture, due to the higher prevalence of inflammatory arthritis in First Nations individuals and the association between inflammatory conditions and osteoporosis.  Many people in remote communities face major barriers to bone density testing, which can delay diagnosis and treatment for osteoporosis and other conditions that increase fracture risk. 

To address this gap, the project will use the FRAX fracture risk assessment tool, an internationally recognized method that estimates a person’s 10-year risk of major osteoporotic fracture and hip fracture using clinical information such as age, medical history, prior fractures, and other risk factors. Because FRAX can be used even when bone density testing is not immediately available, it can help care providers make earlier decisions about prevention, education, and treatment.

The project is being led by Dr. David Kendler, Dr. Leo Lai, and Carrier Sekani Family Services in partnership with rheumatologists, primary care providers, allied health professionals, patient partners, cultural advisors, and health authority representatives. The project commenced in the Spring of 2026. Over a two-year period, the team will provide fracture risk assessments, train providers and clinic staff, develop culturally informed educational materials, and evaluate how the approach supports patient care.

The overall goal is to make fracture prevention more accessible, improve awareness of bone health, support earlier intervention, and help reduce avoidable fractures that can seriously affect mobility, independence, and quality of life.

Project updates and materials will be posted here, as they become available.

Clarifying clinically treatment-naive status for osteoporosis patients

Patients requiring bone anabolic therapy with romosozumab should be treatment naïve per recent studies. Provincial formularies' interpretation of "treatment naïve" has been quite variable. A scientifically valid definition of "clinically treatment naïve" has been explored.

Link to Article:

https://link.springer.com/article/10.1007/s00198-026-07864-3

FDA Approves the First Surrogate Endpoint in Osteoporosis Clinical Trials

The U.S. Food and Drug Administration (FDA) has qualified image-based bone mineral density (BMD) biomarkers as a surrogate endpoint for fractures in clinical trials of osteoporosis therapies, marking an important advance in drug development. This milestone resulted from the Study to Advance BMD as a Regulatory Endpoint (SABRE), a multi-sector collaboration initiated by the American Society for Bone and Mineral Research (ASBMR) and the Foundation for the National Institutes of Health (FNIH) Biomarkers Consortium, and led by ASBMR experts Dennis Black, PhD, Mary Bouxsein, PhD, and Richard Eastell, MD. ASBMR provided financial and institutional support through sustained public–private partnerships, with ongoing leadership from multiple ASBMR Councils and presidents, most recently Drs. Peter Ebeling, Mary Bouxsein, Laura Calvi, and Jennifer Westendorf.

Historically, FDA approval of osteoporosis therapies has relied on fracture outcomes, which are relatively infrequent events and therefore require large, lengthy, and costly clinical trials, limiting innovation—particularly for novel or combination treatments. By qualifying image-based BMD as a surrogate endpoint, the FDA formally recognizes that BMD improvements reliably predict fracture risk reduction, enabling smaller and shorter trials, lowering development costs, accelerating patient access to new therapies (including anabolic and sequential approaches), and facilitating studies in high-risk or niche populations where fracture endpoints are impractical. Clinically, this decision validates long-standing practice that BMD is a meaningful marker of treatment benefit, and strategically, it aligns osteoporosis with other fields that use biologically sound surrogate endpoints to drive progress, with the potential to substantially reduce the current treatment gap.

To learn more, watch this video by ASBMR where Dr. Black and Dr. Bouxsein further discuss the impact of this decision.