Vital osteoporosis program returns to Ontario

With more than half a million Ontarians affected by osteoporosis, a highly debilitating disease that causes bones to become thin and porous, it’s no wonder that standards of testing at digital imaging facilities and quality patient health management is a priority.

The Ontario Association of Radiologists (OAR) is once again offering its Canadian Bone Mineral Densitometry (CBMD) Facility Accreditation Program and two continuing medical education (CME) programs this fall, aimed at radiologists and other physicians reading BMD and technologists providing BMD services, to meet this need.

It’s an unfortunate reality that osteoporosis is a growing health problem for Canadians and remains a large burden on our health care system.  Although both women and men can lose bone mass as they age, women lose bone at a greater rate (from two to three per cent per year) as they approach menopause.


In Canada, more than 80 per cent of all fractures after age 50 are caused by osteoporosis.  The overall yearly cost to the Canadian health care system of treating osteoporosis and the fractures it causes was over $2.3 billion as of 2010.  Fractures from osteoporosis cause pain and may lead to permanent deformities, risk of institutionalization, long-term disability or even death.  They are more common than heart attack stroke and breast cancer combined.  Hip fractures cause more illness, death and higher health care costs than other types of fractures.

Bone density testing is critical, because osteoporosis is often called the “silent thief” since bone loss does not have any symptoms, until a fracture occurs. Unlike the majority of diagnostic imaging procedures, bone densitometry is not just performed to arrive at a diagnosis.  It plays an essential role in monitoring patients who are at risk of developing osteoporosis, or are being treated for high fracture risk.

Because the technique is quantitative rather than qualitative, there is a relatively greater need to ensure that standards are met and proper quality control procedures in place.  Equally, because the technique is only part of a clinical risk assessment, it is necessary for a reporting physician to demonstrate adequate knowledge of osteoporosis as a disease and not merely its radiological assessment.


Before 2006, the quality of bone mineral density (BMD) services offered in Ontario was inconsistent.  Canadian BMD training for physicians and technologists and quality control standard for BMD facilities were non-existent.  Recognizing the need for quality control and standardization, Osteoporosis Canada (OC) on behalf of the Ontario Ministry of Health asked the OAR to develop a quality assurance proposal to support BMD facility accreditation throughout Ontario, as part of the Ministry of Health’s Osteoporosis Strategy in Ontario.

The OAR’s program evolved out of necessity and a commitment to ensure the highest standard of BMD examinations for Ontarians.  It developed a two-pronged program – a facility quality control and quality assurance program and a CME component for medical specialists interpreting and technologists performing BMD services.

The program resulted in a successful four-year pilot project, which demonstrated many significant benefits for the provision of important BMD services for the detection of bone loss and osteoporosis.  Since the program began in March 2007, close to one-third of Ontario’s 300+ BMD units have been CBMD accredited.

An evaluation of the OAR CBMD facility accreditation pilot project, with the involvement of U of T’s osteoporosis researchers, concluded that the program had a profound influence on improving the quality of scanning services provided by the participating sites between 2008 and 2010.  Despite the program’s high level of success, it was put in jeopardy in March of 2012, when the Ministry of Health and Long Term care discontinued funding and reversed its commitment to providing accreditation as part of the province’s Osteoporosis Strategy.

Recognizing the deep void that existed with the suspension of its program, the OAR’s board of directors unanimously agreed to re-develop the CBMD Facility Accreditation Program as an online program.  Launching later this year, the program promises to continue to provide a thorough analysis of all the elements essential to providing a high-quality BMD service delivering the highest standard in quality patient care.  The CBMD goal is to have every bone densitometry unit in Ontario accredited.  All radiology clinics in Ontario are now required to be CBMD accredited by the College of Physicians & Surgeons of Ontario (CPSO).

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