2019 FLS Comprehensive Audit

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Section 1: Information about your FLS
Within OC’s FLS Registry and for the purposes of this audit, FLSs are assessed by individual hospital sites. For hospital corporations which may operate an FLS at two or more separate sites, a separate submission form must be filled out for each individual FLS site. For any questions in filling out this questionnaire, please contact Luanne Schenkels at lschenkels@osteoporosis.ca
FLS site information
Person submitting this form:
First name Last name
Email of submitter
1. Name of your hospital/site, exactly as it should appear on the OC FLS Registry:
Address of FLS site
Street Address Address Line 2 City Province Postal Code

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Section 2: Staff working for your FLS
a. Dedicated FLS coordinator’s name:
First Last
FTE's at this site:
Educational background of the FLS coordinator:
- i) RN
- ii) NP
- iii) RPN/LPN
- iv) Other
Other, please specify:
Has the FLS coordinator been absent from the FLS (e.g. medical leave) for more than 4 consecutive weeks between April 1, 2019 and September 30th, 2019?
- Yes
- No
If yes, please provide details:
Is there more than one FLS Coordinator working at your site?
- No
- Yes, there is one additional FLS Coordinator working at our site.
- Yes, there are more than 2 FLS Coordinators working at our site. Please provide details in the comments section.
Comments (name of additional FLS Coordinators, FTEs, educational background and if on leave for longer that 4 consecutive weeks):
a.i. Dedicated FLS coordinator’s name:
First Last
FTE's at this site:
Educational background of the FLS coordinator:
- i) RN
- ii) NP
- iii) RPN/LPN
- iv) Other
Other, please specify:
Has the FLS coordinator been absent from the FLS (e.g. medical leave) for more than 4 consecutive weeks between April 1, 2019 and September 30th, 2019?
- Yes
- No
If yes, please provide details:
b. FLS Medical Lead's name:
First Last
Medical lead's specialty or background (e.g. osteoporosis specialist, orthopaedic surgeon, care of the elderly physician, family physician, other):
Medical lead's email address:
Estimated time commitment of medical lead to the FLS work:
Any further information:
c. Additional staff:
- Administrative support
- Manager/administrator
- Other
Other, please specify:

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Section 3: Type of FLS
3. Method by which the majority (> 50%) of the fragility fracture patients are identified/captured/enrolled in your FLS.
(Click only one answer)
- a. Referrals are sent to/received by the FLS.
- b. The FLS coordinator does systematic and pro-active case finding of the fragility fracture patients.
- c. Other.
Please describe the referral process including the estimated number and type of healthcare providers who refer to your FLS.
Please briefly describe the process for systematic and pro-active case finding for patients admitted to hospital with a fragility fracture (if applicable).
Please briefly describe the process for systematic and pro-active case finding for patients seen in the hospital’s orthopaedic outpatient clinics (if applicable).
Please describe how the majority (> 50%) of the patients are identified/captured/enrolled in your FLS.
4. Type of FLS:
(Click only one answer)
- a. Hip-only FLS falling under the “no dedicated FLS coordinator” exception rule. All of the hospital’s admitted fragility hip fracture patients are automatically referred to an osteoporosis specialist.
- b. Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the orthopaedic inpatient ward). Our FLS enrolls only hip fracture patients.
- c. Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the inpatient ward). Our FLS enrolls more than just hip fracture patients.
- d. Outpatient-only FLS (i.e. the FLS coordinator first meets the patient directly in the orthopaedic outpatient clinics).
- e. Combined inpatient/outpatient FLS (i.e. the FLS coordinator does systematic and pro-active case finding both on the orthopaedic inpatient ward AND in the orthopaedic outpatient clinics. Some patients, e.g. hip fracture patients, are first seen in person while still on the orthopaedic ward and others, e.g. wrist fracture patients, are first seen in person during their visit to the orthopaedic outpatient clinic).
- f. Other.
Briefly describe your model, including how the systematic and pro-active case finding occurs.
When/where does the osteoporosis specialist see the majority (> 50%) of the hip fracture patients ?
(Click only one answer)
- a. Patient is seen by the osteoporosis specialist while the patient is still hospitalized on the inpatient orthopaedic ward.
- b. Patient is given an appointment to see the osteoporosis specialist post-discharge on the same day and location as his/her appointment at the orthopaedic outpatient clinic.
- c. Patient is given an appointment to see the osteoporosis specialist post-discharge on the same day and location as his/her appointment for BMD testing.
- d. Patient is given an appointment to see the osteoporosis specialist post-discharge, unrelated to either of the appointments at the orthopaedic clinic or the BMD testing. Please provide any other relevant details.
- e. Other. Please specify.
Please elaborate here if needed:
Please elaborate here if needed:
Annual number of hip fractures (12 consecutive months, must be from within the last 3 years) admitted to or discharged from your hospital as per your hospital’s administrative database (must be a database independent from your own FLS’s database):
Time frame of (Annual number of hip fractures):
Please specify when orthopaedic clinics are held in your hospital.
(Click all that apply)
- Monday morning
- Monday afternoon
- Tuesday morning
- Tuesday afternoon
- Wednesday morning
- Wednesday afternoon
- Thursday morning
- Thursday afternoon
- Friday morning
- Friday afternoon
- Saturday morning
- Saturday afternoon
- Sunday morning
- Sunday afternoon
Please specify which orthopaedic clinics are attended by your FLS coordinator (in a typical week).
(Click all that apply)
- Monday morning
- Monday afternoon
- Tuesday morning
- Tuesday afternoon
- Wednesday morning
- Wednesday afternoon
- Thursday morning
- Thursday afternoon
- Friday morning
- Friday afternoon
- Saturday morning
- Saturday afternoon
- Sunday morning
- Sunday afternoon
Please specify when orthopaedic clinics are held in your hospital.
(Click all that apply)
- Monday morning
- Monday afternoon
- Tuesday morning
- Tuesday afternoon
- Wednesday morning
- Wednesday afternoon
- Thursday morning
- Thursday afternoon
- Friday morning
- Friday afternoon
- Saturday morning
- Saturday afternoon
- Sunday morning
- Sunday afternoon
Please specify which orthopaedic clinics are attended by your FLS coordinator (in a typical week).
(Click all that apply)
- Monday morning
- Monday afternoon
- Tuesday morning
- Tuesday afternoon
- Wednesday morning
- Wednesday afternoon
- Thursday morning
- Thursday afternoon
- Friday morning
- Friday afternoon
- Saturday morning
- Saturday afternoon
- Sunday morning
- Sunday afternoon
If you have clicked on 'f" above, before going any further with this questionnaire...
...please provide a brief overview of your program to Luanne Schenkels at Lschenkels@osteoporosis.ca and you will be contacted promptly with guidance for your specific program.

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Section 4: FLS Processes
5. What fracture risk determination tool is used by your FLS in the majority (> 50%) of FLS patients?
(Click only one answer)
- a. Our FLS only includes hip fracture patients. All patients with a fragility hip fracture are deemed HIGH RISK.
- b. CAROC
- c. FRAX with BMD
- d. FRAX without BMD
- e. Other
In your FLS, who is responsible for ordering the patient’s BMD in the majority (> 50%) of cases?
(Click only one answer)
- a. All fragility fracture patients are automatically referred from the FLS directly to an osteoporosis specialist/clinic. The osteoporosis specialist orders the BMD.
- b. FLS coordinator
- c. FLS medical lead
- d. Patient’s orthopaedic surgeon, coordinated by the FLS coordinator
- e. Patient’s orthopaedic surgeon, at their discretion
- f. A letter is sent out to the patient’s primary care provider with a strong recommendation to do a BMD test. The BMD is ordered by the patient’s primary care provider.
- g. Other, please specify.
If other, please specify
In your FLS, who is responsible for ordering the patient’s BMD in the majority (> 50%) of cases?
(Click only one answer)
- a. All fragility fracture patients are automatically referred from the FLS directly to an osteoporosis specialist/clinic. The osteoporosis specialist orders the BMD.
- b. FLS coordinator
- c. FLS medical lead
- d. Patient’s orthopaedic surgeon, coordinated by the FLS coordinator
- e. Patient’s orthopaedic surgeon, at their discretion
- f. A letter is sent out to the patient’s primary care provider with a strong recommendation to do a BMD test. The BMD is ordered by the patient’s primary care provider.
- g. Other, please specify.
If other, please specify
If other, please specify
6. In your FLS, who determines the fracture risk for the majority (>50%) of the FLS patients?
(Click only one answer)
- a. All fragility fracture patients are automatically referred from the FLS directly to an osteoporosis specialist/clinic. The osteoporosis specialist orders the BMD.
- b. FLS coordinator
- c. FLS medical lead
- d. The radiologist who interprets the BMD test
- e. Other, please specify:
If other, please specify:
7. For the majority (> 50%) of the patients seen by your FLS who are deemed to be HIGH RISK, who prescribes the first-line osteoporosis medication?
(Click only one answer)
- a. All HIGH RISK patients are automatically referred from the FLS directly to an osteoporosis specialist/clinic. The osteoporosis specialist prescribes the osteoporosis medication.
- b. FLS coordinator
- c. FLS medical lead
- d. Patient’s orthopaedic surgeon, coordinated by the FLS coordinator
- e. Patient’s orthopaedic surgeon, at their discretion
- f. A letter is sent out to the patient’s primary care provider with a strong recommendation to initiate first-line osteoporosis treatment. The medication is prescribed by the patient’s primary care provider.
- g. The BMD report goes directly to the patient’s primary care provider. The primary care provider can make a decision regarding the need for osteoporosis treatment based on the BMD results.
- h. Other, please specify.
If other, please specify:
8. For HIGH RISK patients, what is included in the communication from the FLS to the patient’s primary care provider?
(Click all that apply)
- a. The patient’s fracture risk (High, Moderate or Low)
- b. The results of any investigations done.
- c. The name of the osteoporosis medication prescribed by the FLS.
- d. A strong recommendation to initiate and/or continue osteoporosis medication.
- e. A list of first-line osteoporosis medications as per OC’s 2010 Osteoporosis Guidelines.
- f. Other
If other, please specify:
9. How is your FLS funded (esp. the salary for the dedicated FLS coordinator)?
- a. Our FLS is a hip-only model which falls under the “no dedicated FLS coordinator” exception rule.
- b. Permanent government/hospital funding
- c. Temporary government/hospital funding. When do you expect your funding to end?
- d. Temporary grant funding. When do you expect your funding to end?
Date expected to end:
Date expected to end:

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Section 5: Annual reporting
10. Annual FLS enrollment reporting:
a. How many fragility fracture patients (aged 50 and up) were newly enrolled in your FLS between April 1, 2019 and March 31, 2020?
b. i) Of the patients in "a" (above), how many were hip (proximal femur) fractures?
b. ii) Of the patients in "a" (above), how many were wrist (distal radius) fractures?
b. iii) Of the patients in "a" (above), how many were shoulder (proximal humerus) fractures?
b. iv) Of the patients in "a" (above), how many were pelvic fractures?
b. v) Of the patients in "a" (above), how many were spine/vertebral fractures?
b. vi) Of the patients in "a" (above), how many were other fracture types?
Please list other fracture types (if applicable):

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Section 6: FLS Audit
1. Our FLS type:
(Click only one answer)
- A. Hip-only FLS falling under the “no dedicated FLS coordinator” exception rule. All of the hospital’s admitted fragility hip fracture patients are automatically referred to an osteoporosis specialist.
- B. Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the orthopaedic inpatient ward). Our FLS enrolls only hip fracture patients.
- C. Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly in the inpatient ward). Our FLS enrolls more than just hip fracture patients.
- D. Outpatient only FLS (i.e. the FLS coordinator first meets the patient directly in the orthopaedic outpatient clinics).
- E. Combined inpatient/outpatient FLS (i.e. the FLS coordinator does systematic and pro-active case finding both on the orthopaedic inpatient ward AND in the orthopaedic outpatient clinics. Some patients, e.g. hip fracture patients, are first seen in person while still on the orthopaedic ward and others, e.g. wrist fracture patients, are first seen in person during their visit to the orthopaedic outpatient clinic).
2. In most hospitals, there is a fairly constant relative proportion of hip fractures to other fracture types (e.g. wrist, shoulder, etc). In regards to your hospital, is there any reason why you believe this typical proportion would not apply?
- My hospital admits all of the hip fracture patients for a larger geographic region which includes other orthopaedic hospitals where fracture patients are only seen in the outpatient orthopaedic clinics.
- My hospital has outpatient orthopaedic clinics, but all/most hip fracture surgery is done at another orthopaedic hospital in my district.
- Other, please describe:
If other, please describe:
A. Hip-only FLS falling under the “no dedicated FLS coordinator” exception rule.
Please refer to OC’s FLS KPIs v2.0 document for any details regarding the numbers to be reported in this audit. You may access the KPIs by copying this link into your browser: https://fls.osteoporosis.ca/indicator/
A.1. How many hip fracture patients were admitted to (or discharged from) your hospital from April 1st, 2019 to September 30, 2019? This data must be from an administrative database independent of your FLS.
A.2. In your FLS, patients are considered enrolled when they first see the osteoporosis specialist. From April 1, 2019 to September 30, 2019, how many fragility hip (proximal femur) fracture patients (aged 50 and up) were newly enrolled in the FLS (i.e. first seen by the osteoporosis specialist) within 26 weeks of their hip fracture?
A.3. Of the patients listed in A.2. above, how many were initiated (or continued) on first-line osteoporosis medication (alendronate, risedronate, zoledronic acid, denosumab or teriparatide) within 26 weeks of their hip fracture?
A.4. How long does your FLS follow the fragility fracture patients?
(Click only one answer)
- a. Less than 6 months. Please specify duration.
- b. 6 months or longer, but less than a year
- c. One year
- d. More than one year. Please specify duration.
Please specify duration (if indicated):
Please specify duration (if indicated):
PERSISTENCE: For the purposes of this survey, persistence is defined as documenting that the patient is still on the osteoporosis medication at 52 weeks post fracture. For patients on zoledronic acid, all patients are deemed persistent if they received their last infusion within 12-18 months prior to their 52-week anniversary from their fracture. For patients on denosumab, patients are considered persistent if no more than 7 months has occurred since their last denosumab injection at the 52-week anniversary from their fracture.
A.5. Does your FLS monitor persistence at 52 weeks post fracture?
- Yes
- No
A.5.a. If yes, we would greatly appreciate if you would be willing to share with us your FLS’s results on persistence. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on persistence?
We are hoping to gather the following: Of the patients listed in A.3., number of patients who are persistent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52 week anniversary from their fracture. And, separately, the number of patients from A.3. where you could not obtain their persistence information at 26 weeks.
- Yes
- No
ADHERENCE: For the purpose of this survey, adherence is defined as those patients who are taking their medication as prescribed by their healthcare provider. This may vary depending on the medication. For oral bisphosphonates (alendronate/risedronate), it is defined as: Taking most of their scheduled doses (e.g. forgetting less than 20% of their scheduled doses) AND also taking their medication in a safe and effective manner (e.g. depending on the oral bisphosphonate, could include taking in the morning, on an empty stomach, etc). • For zoledronic acid, adherence is automatically ensured for 12-18 months following the first dose • For denosumab, remaining faithful with the scheduled doses (i.e. no more than 7 months between doses) • For teriparatide, taking more than 80% of their daily injections.
A.6. Does your FLS monitor adherence?
- Yes
- No
A.6.a. If yes, at what time points is this monitored?
A.6.b. Please provide any other details regarding your monitoring of adherence.
A.6.c If your FLS monitors adherence, we would greatly appreciate if you would be willing to share with us your FLS’s results. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on adherence?
Specifically, we will be looking for the following: Of the patients listed in A.3., number of patients who are both persistent and adherent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52 week anniversary from their fracture. And, separately, provide us the number of patients from A.3. where you could not obtain their adherence information at 26 weeks.
- Yes
- No
B: Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the orthopaedic inpatient ward). Our FLS enrolls only hip fracture patients.
Please refer to OC’s FLS KPIs v2.0 document for any details regarding the numbers to be reported in this audit. You may access the KPIs by copying this link into your browser: https://fls.osteoporosis.ca/indicator/
B.1. How many hip fracture patients were admitted to (or discharged from) your hospital from April 1st, 2019 to September 30, 2019? This data must be from an administrative database independent of your FLS.
B.2. From April 1, 2019 to September 30, 2019, how many fragility hip fracture patients (aged 50 and up) were newly enrolled in the FLS (i.e. first seen by the FLS coordinator) within 6 weeks of their hip fracture?
B.3. Of the patients listed in B.2. above:
B.3.a. How many were initiated (or continued) on first-line osteoporosis medication (alendronate, risedronate, zoledronic acid, denosumab or teriparatide) within 26 weeks of their hip fracture?
B.3.b. How many were not initiated a first-line osteoporosis medication within 26 weeks of their hip fractures?
B.3.c. How many are you not sure if the patient was initiated or not on osteoporosis medication within 26 weeks (e.g. patient lost to follow-up)?
B.4. How is treatment initiation ascertained for the majority (> 50%) of HIGH RISK patients in your FLS?
(Click only one answer)
- a. Our FLS provides the prescription to the patient directly.
- b. Patient self-report upon follow-up visit or phone call.
- c. Medication has been dispensed as per a pharmaceutical or administrative database. Please specify database.
- d. Other
Please provide details (if indicated):
Please provide details (if indicated):
PERSISTENCE: For the purposes of this survey, persistence is defined as documenting that the patient is still on the osteoporosis medication at 52 weeks post fracture. For patients on zoledronic acid, all patients are deemed persistent if they received their last infusion within 12-18 months prior to their 52-week anniversary from their fracture. For patients on denosumab, patients are considered persistent if no more than 7 months has occurred since their last denosumab injection at the 52-week anniversary from their fracture.
B.5. Does your FLS monitor persistence at 52 weeks post fracture?
- Yes
- No
B.5.a. If yes, we would greatly appreciate if you would be willing to share with us your FLS’s results on persistence. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on persistence?
Specifically, we will be looking for the following: Of the patients listed in 3a, number of patients who are persistent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52-week anniversary from their fracture. And, separately, provide us the number of patients from 3a where you could not obtain their persistence information at 52 weeks.
- Yes
- No
ADHERENCE: For the purpose of this survey, adherence is defined as those patients who are taking their medication as prescribed by their healthcare provider. This may vary depending on the medication. For oral bisphosphonates (alendronate/risedronate), it is defined as: Taking most of their scheduled doses (e.g. forgetting less than 20% of their scheduled doses) AND also taking their medication in a safe and effective manner (e.g. depending on the oral bisphosphonate, could include taking in the morning, on an empty stomach, etc). • For zoledronic acid, adherence is automatically ensured for 12-18 months following the first dose • For denosumab, remaining faithful with the scheduled doses (i.e. no more than 7 months between doses) • For teriparatide, taking more than 80% of their daily injections.
B.6. Does your FLS monitor adherence?
- Yes
- No
B.6.a. If yes, at what time points is this monitored?
B.6.b. Any other details regarding your monitoring of adherence:
B.6.c. If your FLS monitors adherence, we would greatly appreciate if you would be willing to share with us your FLS’s results. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on adherence?
Specifically, we will be looking for the following: Of the patients listed in 3a, number of patients who are both persistent and adherent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52-week anniversary from their fracture. And, separately, provide us the number of patients from 3a where you could not obtain their adherence information at 52 weeks.
- Yes
- No
C: Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the orthopaedic inpatient ward). Our FLS enrolls more than just hip fracture patients.
Please refer to OC’s FLS KPIs v2.0 document for any details regarding the numbers to be reported in this audit. You may access the KPIs by copying this link into your browser: https://fls.osteoporosis.ca/indicator/
C.1. How many hip fracture patients were admitted to (or discharged from) your hospital from April 1st, 2019 to September 30, 2019? This data must be from an administrative database independent of your FLS.
C.2. From April 1, 2019 to September 30, 2019, how many fragility fracture patients (aged 50 and up) were newly enrolled in the FLS (i.e. first seen by the FLS coordinator) within 6 weeks of their fracture?
a. Hip (proximal femur) fractures
b. Wrist (distal radius) fractures
c. Shoulder (proximal humerus) fractures
d. Pelvic fractures
e. Spine/vertebral fractures
C.3. Of the total non-spine fracture patients listed in 2f above, number of patients where the fracture risk was determined within 26 weeks to be:
a. HIGH RISK
b. MODERATE RISK
c. LOW RISK
d. Fracture risk could not be determined within 26 weeks
C.4. Of the HIGH RISK patients listed in C.3.a above:
C.4.a. How many were initiated (or continued) on first-line osteoporosis medication (alendronate, risedronate, zoledronic acid, denosumab or teriparatide) within 26 weeks of their fracture?
C.4.b. How many were not initiated a first-line osteoporosis medication within 26 weeks of their fractures?
C.4.c. How many are you not sure if the patient was initiated or not on osteoporosis medication within 26 weeks (e.g. patient lost to follow-up)?
C.5. How is treatment initiation ascertained for the majority (> 50%) of HIGH RISK patients in your FLS?
(Click only one answer)
- a. Our FLS provides the prescription to the patient directly.
- b. Patient self-report upon follow-up visit or phone call.
- c. Medication has been dispensed as per a pharmaceutical or administrative database. Please specify database.
- d. Other
Please specify database or other details:
Please specify database or other details:
PERSISTENCE: For the purposes of this survey, persistence is defined as documenting that the patient is still on the osteoporosis medication at 52 weeks post fracture. For patients on zoledronic acid, all patients are deemed persistent if they received their last infusion within 12-18 months prior to their 52-week anniversary from their fracture. For patients on denosumab, patients are considered persistent if no more than 7 months has occurred since their last denosumab injection at the 52-week anniversary from their fracture.
C.6. Does your FLS monitor persistence at 52 weeks post fracture?
- Yes
- No
C.6.a. If yes, we would greatly appreciate if you would be willing to share with us your FLS’s results on persistence. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest).Can we contact you in December 2019 to request your FLS’s results on persistence?
Specifically, we will be looking for the following: Of the patients listed in 3a, number of patients who are persistent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52-week anniversary from their fracture. And, separately, provide us the number of patients from 3a where you could not obtain their persistence information at 52 weeks.
- Yes
- No
ADHERENCE: For the purpose of this survey, adherence is defined as those patients who are taking their medication as prescribed by their healthcare provider. This may vary depending on the medication. For oral bisphosphonates (alendronate/risedronate), it is defined as: Taking most of their scheduled doses (e.g. forgetting less than 20% of their scheduled doses) AND also taking their medication in a safe and effective manner (e.g. depending on the oral bisphosphonate, could include taking in the morning, on an empty stomach, etc). • For zoledronic acid, adherence is automatically ensured for 12-18 months following the first dose • For denosumab, remaining faithful with the scheduled doses (i.e. no more than 7 months between doses) • For teriparatide, taking more than 80% of their daily injections.
C.7 Does your FLS monitor adherence?
- Yes
- No
C.7.a. If yes, at what time points is this monitored?
C.7.b. Any other details regarding your monitoring of adherence
C.7.c. If your FLS monitors adherence, we would greatly appreciate if you would be willing to share with us your FLS’s results. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on adherence?
Can we contact you in December 2019 to request your FLS’s results on adherence? Specifically, we will be looking for the following: Of the patients listed in 3a, number of patients who are both persistent and adherent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52-week anniversary from their fracture. And, separately, provide us the number of patients from 3a where you could not obtain their adherence information at 52 weeks.
- Yes
- No
D: Outpatient-only (i.e. the FLS coordinator first meets the patient directly in the orthopaedic outpatient clinics)
Please refer to OC’s FLS KPIs v2.0 document for any details regarding the numbers to be reported in this audit. You may access the KPIs by copying this link into your browser: https://fls.osteoporosis.ca/indicator/
D.1. How many hip fracture patients were admitted to (or discharged from) your hospital from April 1st, 2019 to September 30, 2019? This data must be from an administrative database independent of your FLS.
D.2. From April 1, 2019 to September 30, 2019, how many fragility fracture patients (aged 50 and up) were newly enrolled in the FLS (i.e. first seen by the FLS coordinator) within 12 weeks of their hip fracture and within 6 weeks for non hip fractures?
a. Hip (proximal femur) fractures (within 12 wks)
b. Wrist (distal radius) fractures (within 6 wks)
c. Shoulder (proximal humerus) fractures (within 6 wks)
d. Pelvic fractures (within 6wks)
e. Spine/vertebral fractures
D.3. Of the total non-spine fracture patients listed above, number of patients where the fracture risk was determined within 26 weeks to be:
a. HIGH RISK
b. MODERATE RISK
c. LOW RISK
d. Fracture risk could not be determined within 26 weeks
D.4. Of the HIGH RISK patients listed in 3a above,
a. How many were initiated (or continued) on first-line osteoporosis medication (alendronate, risedronate, zoledronic acid, denosumab or teriparatide) within 26 weeks of their fracture?
b. How many were not initiated a first-line osteoporosis medication within 26 weeks of their fractures?
c. How many are you not sure if the patient was initiated or not on osteoporosis medication within 26 weeks (e.g. patient lost to follow-up)?
D.5. How is treatment initiation ascertained for the majority (> 50%) of HIGH RISK patients in your FLS?
(Click only one answer)
- a. Our FLS provides the prescription to the patient directly.
- b. Patient self-report upon follow-up visit or phone call.
- c. Medication has been dispensed as per a pharmaceutical or administrative database. Please specify database.
- d. Other
Please specify database or other:
Please specify database or other:
PERSISTENCE: For the purposes of this survey, persistence is defined as documenting that the patient is still on the osteoporosis medication at 52 weeks post fracture. For patients on zoledronic acid, all patients are deemed persistent if they received their last infusion within 12-18 months prior to their 52-week anniversary from their fracture. For patients on denosumab, patients are considered persistent if no more than 7 months has occurred since their last denosumab injection at the 52-week anniversary from their fracture.
D.6. Does your FLS monitor persistence at 52 weeks post fracture?
- Yes
- No
D.6.a. If yes, we would greatly appreciate if you would be willing to share with us your FLS’s results on persistence. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on persistence?
Specifically, we will be looking for the following: Of the patients listed in 3a, number of patients who are persistent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52-week anniversary from their fracture. And, separately, provide us the number of patients from 3a where you could not obtain their persistence information at 52 weeks.
- Yes
- No
ADHERENCE: For the purpose of this survey, adherence is defined as those patients who are taking their medication as prescribed by their healthcare provider. This may vary depending on the medication. • For oral bisphosphonates (alendronate/risedronate), it is defined as: o Taking most of their scheduled doses (e.g. forgetting less than 20% of their scheduled doses) AND o Also taking their medication in a safe and effective manner (e.g. depending on the oral bisphosphonate, could include taking in the morning, on an empty stomach, etc). • For zoledronic acid, adherence is automatically ensured for 12-18 months following the first dose • For denosumab, remaining faithful with the scheduled doses (i.e. no more than 7 months between doses) • For teriparatide, taking more than 80% of their daily injections.
D.7. Does your FLS monitor adherence?
- Yes
- No
D.7.a. If yes, at what time points is this monitored?
D.7.b. Any other details regarding your monitoring of adherence:
D.7.c. If your FLS monitors adherence, we would greatly appreciate if you would be willing to share with us your FLS’s results. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on adherence?
Specifically, we will be looking for the following: Of the patients listed in 3a, number of patients who are both persistent and adherent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52-week anniversary from their fracture. And, separately, provide us the number of patients from 3a where you could not obtain their adherence information at 52 weeks.
- Yes
- No
E: Combined inpatient/outpatient FLS (i.e. the FLS coordinator does systematic and pro-active case finding both on the orthopaedic inpatient ward AND in the orthopaedic outpatient clinics).
Please refer to OC’s FLS KPIs v2.0 document for any details regarding the numbers to be reported in this audit. You may access the KPIs by copying this link into your browser: https://fls.osteoporosis.ca/indicator/
E.1. How many hip fracture patients were admitted to (or discharged from) your hospital from April 1st, 2019 to September 30, 2019? This data must be from an administrative database independent of your FLS.
E.2. From April 1, 2019 to September 30, 2019, how many fragility fracture patients (aged 50 and up) were newly enrolled in the FLS (i.e. first seen by the FLS coordinator) within 12 weeks of their hip fracture and 6 weeks of their non hip fracture?
a. Hip (proximal femur) fractures (within 12 wks)
b. Wrist (distal radius) fractures (within 6 wks)
c. Shoulder (proximal humerus) fractures (within 6 wks)
d. Pelvic fractures (within 6 wks)
e. Spine/vertebral fractures
E.3. Of the total non-spine fracture patients listed above, number of patients where the fracture risk was determined within 26 weeks to be:
a. HIGH RISK
b. MODERATE RISK
c. LOW RISK
d. Fracture risk could not be determined within 26 weeks
E.4. Of the HIGH RISK patients listed in 3a above:
a. How many were initiated (or continued) on first-line osteoporosis medication (alendronate, risedronate, zoledronic acid, denosumab or teriparatide) within 26 weeks of their fracture?
b. How many were not initiated a first-line osteoporosis medication within 26 weeks of their fractures?
c. How many are you not sure if the patient was initiated or not on osteoporosis medication within 26 weeks (e.g. patient lost to follow-up)?
E.5. How is treatment initiation ascertained for the majority (> 50%) of HIGH RISK patients in your FLS?
(Click only one answer)
- a. Our FLS provides the prescription to the patient directly.
- b. Patient self-report upon follow-up visit or phone call.
- c. Medication has been dispensed as per a pharmaceutical or administrative database. Please specify database.
- d. Other
Please specify database or other:
Please specify database or other:
PERSISTENCE: For the purposes of this survey, persistence is defined as documenting that the patient is still on the osteoporosis medication at 52 weeks post fracture. For patients on zoledronic acid, all patients are deemed persistent if they received their last infusion within 12-18 months prior to their 52-week anniversary from their fracture. For patients on denosumab, patients are considered persistent if no more than 7 months has occurred since their last denosumab injection at the 52-week anniversary from their fracture.
E.6. Does your FLS monitor persistence at 52 weeks post fracture?
- Yes
- No
E.6.a. If yes, we would greatly appreciate if you would be willing to share with us your FLS’s results on persistence. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on persistence?
Specifically, we will be looking for the following: Of the patients listed in 3a, number of patients who are persistent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52-week anniversary from their fracture. And, separately, provide us the number of patients from 3a where you could not obtain their persistence information at 52 weeks.
- Yes
- No
ADHERENCE: For the purpose of this survey, adherence is defined as those patients who are taking their medication as prescribed by their healthcare provider. This may vary depending on the medication. • For oral bisphosphonates (alendronate/risedronate), it is defined as: o Taking most of their scheduled doses (e.g. forgetting less than 20% of their scheduled doses) AND o Also taking their medication in a safe and effective manner (e.g. depending on the oral bisphosphonate, could include taking in the morning, on an empty stomach, etc). • For zoledronic acid, adherence is automatically ensured for 12-18 months following the first dose • For denosumab, remaining faithful with the scheduled doses (i.e. no more than 7 months between doses) • For teriparatide, taking more than 80% of their daily injections.
E.7. Does your FLS monitor adherence?
- Yes
- No
E.7.a. If yes, at what time points is this monitored?
E.7.b. Any other details regarding your monitoring of adherence:
E.7.c. If your FLS monitors adherence, we would greatly appreciate if you would be willing to share with us your FLS’s results. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on adherence?
Specifically, we will be looking for the following: Of the patients listed in 3a, number of patients who are both persistent and adherent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52-week anniversary from their fracture. And, separately, provide us the number of patients from 3a where you could not obtain their adherence information at 52 weeks.
- Yes
- No

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Section 7: Information on vertebral fractures
1. How would you describe the vertebral fracture patients seen by your FLS?
(Click all that apply)
- a) Limited to acute vertebral fractures referred to/seen by orthopaedic services (inpatients and/or outpatients).
- b) Our FLS accepts spine fracture patients (acute/clinical or radiologic) by referral to our FLS, even if they are not seen by the orthopaedic service.
- c) Our FLS does spine x-rays and/or VFA on the enrolled non-spine fracture patients. Many previously undocumented spine fractures are identified with this process.
- d) Our FLS does not do routine spine x-rays and/or VFA on the enrolled non-spine fracture patients. However, we review the patient’s prior spine x-rays to see if there were any documented vertebral fractures.
- e) Our FLS does systematic and pro-active case finding of all acute vertebral fractures admitted to our hospital, whether patient is admitted to orthopaedic service or other medical services.
- f) Our FLS does systematic and pro-active case finding of all acute vertebral fractures presenting to our hospital’s emergency department.
- g) Our FLS does systematic and pro-active case finding of all acute and incidental vertebral fracture patients presenting to our hospital’s diagnostic imaging (DI) department by scanning DI reports. This includes DI reports on community patients coming in for their x-rays at our hospital’s diagnostic imaging department (e.g. a Chest x-ray ordered by the patient’s family physician to rule out pneumonia).
2. Do you give us permission to contact you for details if more information is needed?
- Yes
- No
Please provide the name of the contact person.
Email of contact person:

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Section 8: Resources and Challenges
1. Do you feel that your FLS is sufficiently resourced?
- Yes
- No
If no, please describe:
2. Please describe your FLS’s major challenges:
3. How can Osteoporosis Canada help/support your FLS?

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Section 9: Permission
Thank you for your collaboration.*
Osteoporosis Canada may use aggregate data from this audit for possible publication and/or research purposes. The individual FLS sites would remain completely anonymous in the event of any publication.
- I consent to the use of the data collected in this questionnaire for the purpose stated above.
- I do not consent to the use of the data collected in this questionnaire for the purpose stated above.

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2019 FLS Comprehensive Audit

Step 1 of 9

11%

Section 1: Information about your FLS
Within OC’s FLS Registry and for the purposes of this audit, FLSs are assessed by individual hospital sites. For hospital corporations which may operate an FLS at two or more separate sites, a separate submission form must be filled out for each individual FLS site. For any questions in filling out this questionnaire, please contact Luanne Schenkels at lschenkels@osteoporosis.ca
FLS site information
Person submitting this form:
First name Last name
Email of submitter
1. Name of your hospital/site, exactly as it should appear on the OC FLS Registry:
Address of FLS site
Street Address Address Line 2 City Province Postal Code

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Section 2: Staff working for your FLS
a. Dedicated FLS coordinator’s name:
First Last
FTE's at this site:
Educational background of the FLS coordinator:
- i) RN
- ii) NP
- iii) RPN/LPN
- iv) Other
Other, please specify:
Has the FLS coordinator been absent from the FLS (e.g. medical leave) for more than 4 consecutive weeks between April 1, 2019 and September 30th, 2019?
- Yes
- No
If yes, please provide details:
Is there more than one FLS Coordinator working at your site?
- No
- Yes, there is one additional FLS Coordinator working at our site.
- Yes, there are more than 2 FLS Coordinators working at our site. Please provide details in the comments section.
Comments (name of additional FLS Coordinators, FTEs, educational background and if on leave for longer that 4 consecutive weeks):
a.i. Dedicated FLS coordinator’s name:
First Last
FTE's at this site:
Educational background of the FLS coordinator:
- i) RN
- ii) NP
- iii) RPN/LPN
- iv) Other
Other, please specify:
Has the FLS coordinator been absent from the FLS (e.g. medical leave) for more than 4 consecutive weeks between April 1, 2019 and September 30th, 2019?
- Yes
- No
If yes, please provide details:
b. FLS Medical Lead's name:
First Last
Medical lead's specialty or background (e.g. osteoporosis specialist, orthopaedic surgeon, care of the elderly physician, family physician, other):
Medical lead's email address:
Estimated time commitment of medical lead to the FLS work:
Any further information:
c. Additional staff:
- Administrative support
- Manager/administrator
- Other
Other, please specify:

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Section 3: Type of FLS
3. Method by which the majority (> 50%) of the fragility fracture patients are identified/captured/enrolled in your FLS.
(Click only one answer)
- a. Referrals are sent to/received by the FLS.
- b. The FLS coordinator does systematic and pro-active case finding of the fragility fracture patients.
- c. Other.
Please describe the referral process including the estimated number and type of healthcare providers who refer to your FLS.
Please briefly describe the process for systematic and pro-active case finding for patients admitted to hospital with a fragility fracture (if applicable).
Please briefly describe the process for systematic and pro-active case finding for patients seen in the hospital’s orthopaedic outpatient clinics (if applicable).
Please describe how the majority (> 50%) of the patients are identified/captured/enrolled in your FLS.
4. Type of FLS:
(Click only one answer)
- a. Hip-only FLS falling under the “no dedicated FLS coordinator” exception rule. All of the hospital’s admitted fragility hip fracture patients are automatically referred to an osteoporosis specialist.
- b. Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the orthopaedic inpatient ward). Our FLS enrolls only hip fracture patients.
- c. Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the inpatient ward). Our FLS enrolls more than just hip fracture patients.
- d. Outpatient-only FLS (i.e. the FLS coordinator first meets the patient directly in the orthopaedic outpatient clinics).
- e. Combined inpatient/outpatient FLS (i.e. the FLS coordinator does systematic and pro-active case finding both on the orthopaedic inpatient ward AND in the orthopaedic outpatient clinics. Some patients, e.g. hip fracture patients, are first seen in person while still on the orthopaedic ward and others, e.g. wrist fracture patients, are first seen in person during their visit to the orthopaedic outpatient clinic).
- f. Other.
Briefly describe your model, including how the systematic and pro-active case finding occurs.
When/where does the osteoporosis specialist see the majority (> 50%) of the hip fracture patients ?
(Click only one answer)
- a. Patient is seen by the osteoporosis specialist while the patient is still hospitalized on the inpatient orthopaedic ward.
- b. Patient is given an appointment to see the osteoporosis specialist post-discharge on the same day and location as his/her appointment at the orthopaedic outpatient clinic.
- c. Patient is given an appointment to see the osteoporosis specialist post-discharge on the same day and location as his/her appointment for BMD testing.
- d. Patient is given an appointment to see the osteoporosis specialist post-discharge, unrelated to either of the appointments at the orthopaedic clinic or the BMD testing. Please provide any other relevant details.
- e. Other. Please specify.
Please elaborate here if needed:
Please elaborate here if needed:
Annual number of hip fractures (12 consecutive months, must be from within the last 3 years) admitted to or discharged from your hospital as per your hospital’s administrative database (must be a database independent from your own FLS’s database):
Time frame of (Annual number of hip fractures):
Please specify when orthopaedic clinics are held in your hospital.
(Click all that apply)
- Monday morning
- Monday afternoon
- Tuesday morning
- Tuesday afternoon
- Wednesday morning
- Wednesday afternoon
- Thursday morning
- Thursday afternoon
- Friday morning
- Friday afternoon
- Saturday morning
- Saturday afternoon
- Sunday morning
- Sunday afternoon
Please specify which orthopaedic clinics are attended by your FLS coordinator (in a typical week).
(Click all that apply)
- Monday morning
- Monday afternoon
- Tuesday morning
- Tuesday afternoon
- Wednesday morning
- Wednesday afternoon
- Thursday morning
- Thursday afternoon
- Friday morning
- Friday afternoon
- Saturday morning
- Saturday afternoon
- Sunday morning
- Sunday afternoon
Please specify when orthopaedic clinics are held in your hospital.
(Click all that apply)
- Monday morning
- Monday afternoon
- Tuesday morning
- Tuesday afternoon
- Wednesday morning
- Wednesday afternoon
- Thursday morning
- Thursday afternoon
- Friday morning
- Friday afternoon
- Saturday morning
- Saturday afternoon
- Sunday morning
- Sunday afternoon
Please specify which orthopaedic clinics are attended by your FLS coordinator (in a typical week).
(Click all that apply)
- Monday morning
- Monday afternoon
- Tuesday morning
- Tuesday afternoon
- Wednesday morning
- Wednesday afternoon
- Thursday morning
- Thursday afternoon
- Friday morning
- Friday afternoon
- Saturday morning
- Saturday afternoon
- Sunday morning
- Sunday afternoon
If you have clicked on 'f" above, before going any further with this questionnaire...
...please provide a brief overview of your program to Luanne Schenkels at Lschenkels@osteoporosis.ca and you will be contacted promptly with guidance for your specific program.

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Section 4: FLS Processes
5. What fracture risk determination tool is used by your FLS in the majority (> 50%) of FLS patients?
(Click only one answer)
- a. Our FLS only includes hip fracture patients. All patients with a fragility hip fracture are deemed HIGH RISK.
- b. CAROC
- c. FRAX with BMD
- d. FRAX without BMD
- e. Other
In your FLS, who is responsible for ordering the patient’s BMD in the majority (> 50%) of cases?
(Click only one answer)
- a. All fragility fracture patients are automatically referred from the FLS directly to an osteoporosis specialist/clinic. The osteoporosis specialist orders the BMD.
- b. FLS coordinator
- c. FLS medical lead
- d. Patient’s orthopaedic surgeon, coordinated by the FLS coordinator
- e. Patient’s orthopaedic surgeon, at their discretion
- f. A letter is sent out to the patient’s primary care provider with a strong recommendation to do a BMD test. The BMD is ordered by the patient’s primary care provider.
- g. Other, please specify.
If other, please specify
In your FLS, who is responsible for ordering the patient’s BMD in the majority (> 50%) of cases?
(Click only one answer)
- a. All fragility fracture patients are automatically referred from the FLS directly to an osteoporosis specialist/clinic. The osteoporosis specialist orders the BMD.
- b. FLS coordinator
- c. FLS medical lead
- d. Patient’s orthopaedic surgeon, coordinated by the FLS coordinator
- e. Patient’s orthopaedic surgeon, at their discretion
- f. A letter is sent out to the patient’s primary care provider with a strong recommendation to do a BMD test. The BMD is ordered by the patient’s primary care provider.
- g. Other, please specify.
If other, please specify
If other, please specify
6. In your FLS, who determines the fracture risk for the majority (>50%) of the FLS patients?
(Click only one answer)
- a. All fragility fracture patients are automatically referred from the FLS directly to an osteoporosis specialist/clinic. The osteoporosis specialist orders the BMD.
- b. FLS coordinator
- c. FLS medical lead
- d. The radiologist who interprets the BMD test
- e. Other, please specify:
If other, please specify:
7. For the majority (> 50%) of the patients seen by your FLS who are deemed to be HIGH RISK, who prescribes the first-line osteoporosis medication?
(Click only one answer)
- a. All HIGH RISK patients are automatically referred from the FLS directly to an osteoporosis specialist/clinic. The osteoporosis specialist prescribes the osteoporosis medication.
- b. FLS coordinator
- c. FLS medical lead
- d. Patient’s orthopaedic surgeon, coordinated by the FLS coordinator
- e. Patient’s orthopaedic surgeon, at their discretion
- f. A letter is sent out to the patient’s primary care provider with a strong recommendation to initiate first-line osteoporosis treatment. The medication is prescribed by the patient’s primary care provider.
- g. The BMD report goes directly to the patient’s primary care provider. The primary care provider can make a decision regarding the need for osteoporosis treatment based on the BMD results.
- h. Other, please specify.
If other, please specify:
8. For HIGH RISK patients, what is included in the communication from the FLS to the patient’s primary care provider?
(Click all that apply)
- a. The patient’s fracture risk (High, Moderate or Low)
- b. The results of any investigations done.
- c. The name of the osteoporosis medication prescribed by the FLS.
- d. A strong recommendation to initiate and/or continue osteoporosis medication.
- e. A list of first-line osteoporosis medications as per OC’s 2010 Osteoporosis Guidelines.
- f. Other
If other, please specify:
9. How is your FLS funded (esp. the salary for the dedicated FLS coordinator)?
- a. Our FLS is a hip-only model which falls under the “no dedicated FLS coordinator” exception rule.
- b. Permanent government/hospital funding
- c. Temporary government/hospital funding. When do you expect your funding to end?
- d. Temporary grant funding. When do you expect your funding to end?
Date expected to end:
Date expected to end:

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Section 5: Annual reporting
10. Annual FLS enrollment reporting:
a. How many fragility fracture patients (aged 50 and up) were newly enrolled in your FLS between April 1, 2019 and March 31, 2020?
b. i) Of the patients in "a" (above), how many were hip (proximal femur) fractures?
b. ii) Of the patients in "a" (above), how many were wrist (distal radius) fractures?
b. iii) Of the patients in "a" (above), how many were shoulder (proximal humerus) fractures?
b. iv) Of the patients in "a" (above), how many were pelvic fractures?
b. v) Of the patients in "a" (above), how many were spine/vertebral fractures?
b. vi) Of the patients in "a" (above), how many were other fracture types?
Please list other fracture types (if applicable):

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Section 6: FLS Audit
1. Our FLS type:
(Click only one answer)
- A. Hip-only FLS falling under the “no dedicated FLS coordinator” exception rule. All of the hospital’s admitted fragility hip fracture patients are automatically referred to an osteoporosis specialist.
- B. Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the orthopaedic inpatient ward). Our FLS enrolls only hip fracture patients.
- C. Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly in the inpatient ward). Our FLS enrolls more than just hip fracture patients.
- D. Outpatient only FLS (i.e. the FLS coordinator first meets the patient directly in the orthopaedic outpatient clinics).
- E. Combined inpatient/outpatient FLS (i.e. the FLS coordinator does systematic and pro-active case finding both on the orthopaedic inpatient ward AND in the orthopaedic outpatient clinics. Some patients, e.g. hip fracture patients, are first seen in person while still on the orthopaedic ward and others, e.g. wrist fracture patients, are first seen in person during their visit to the orthopaedic outpatient clinic).
2. In most hospitals, there is a fairly constant relative proportion of hip fractures to other fracture types (e.g. wrist, shoulder, etc). In regards to your hospital, is there any reason why you believe this typical proportion would not apply?
- My hospital admits all of the hip fracture patients for a larger geographic region which includes other orthopaedic hospitals where fracture patients are only seen in the outpatient orthopaedic clinics.
- My hospital has outpatient orthopaedic clinics, but all/most hip fracture surgery is done at another orthopaedic hospital in my district.
- Other, please describe:
If other, please describe:
A. Hip-only FLS falling under the “no dedicated FLS coordinator” exception rule.
Please refer to OC’s FLS KPIs v2.0 document for any details regarding the numbers to be reported in this audit. You may access the KPIs by copying this link into your browser: https://fls.osteoporosis.ca/indicator/
A.1. How many hip fracture patients were admitted to (or discharged from) your hospital from April 1st, 2019 to September 30, 2019? This data must be from an administrative database independent of your FLS.
A.2. In your FLS, patients are considered enrolled when they first see the osteoporosis specialist. From April 1, 2019 to September 30, 2019, how many fragility hip (proximal femur) fracture patients (aged 50 and up) were newly enrolled in the FLS (i.e. first seen by the osteoporosis specialist) within 26 weeks of their hip fracture?
A.3. Of the patients listed in A.2. above, how many were initiated (or continued) on first-line osteoporosis medication (alendronate, risedronate, zoledronic acid, denosumab or teriparatide) within 26 weeks of their hip fracture?
A.4. How long does your FLS follow the fragility fracture patients?
(Click only one answer)
- a. Less than 6 months. Please specify duration.
- b. 6 months or longer, but less than a year
- c. One year
- d. More than one year. Please specify duration.
Please specify duration (if indicated):
Please specify duration (if indicated):
PERSISTENCE: For the purposes of this survey, persistence is defined as documenting that the patient is still on the osteoporosis medication at 52 weeks post fracture. For patients on zoledronic acid, all patients are deemed persistent if they received their last infusion within 12-18 months prior to their 52-week anniversary from their fracture. For patients on denosumab, patients are considered persistent if no more than 7 months has occurred since their last denosumab injection at the 52-week anniversary from their fracture.
A.5. Does your FLS monitor persistence at 52 weeks post fracture?
- Yes
- No
A.5.a. If yes, we would greatly appreciate if you would be willing to share with us your FLS’s results on persistence. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on persistence?
We are hoping to gather the following: Of the patients listed in A.3., number of patients who are persistent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52 week anniversary from their fracture. And, separately, the number of patients from A.3. where you could not obtain their persistence information at 26 weeks.
- Yes
- No
ADHERENCE: For the purpose of this survey, adherence is defined as those patients who are taking their medication as prescribed by their healthcare provider. This may vary depending on the medication. For oral bisphosphonates (alendronate/risedronate), it is defined as: Taking most of their scheduled doses (e.g. forgetting less than 20% of their scheduled doses) AND also taking their medication in a safe and effective manner (e.g. depending on the oral bisphosphonate, could include taking in the morning, on an empty stomach, etc). • For zoledronic acid, adherence is automatically ensured for 12-18 months following the first dose • For denosumab, remaining faithful with the scheduled doses (i.e. no more than 7 months between doses) • For teriparatide, taking more than 80% of their daily injections.
A.6. Does your FLS monitor adherence?
- Yes
- No
A.6.a. If yes, at what time points is this monitored?
A.6.b. Please provide any other details regarding your monitoring of adherence.
A.6.c If your FLS monitors adherence, we would greatly appreciate if you would be willing to share with us your FLS’s results. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on adherence?
Specifically, we will be looking for the following: Of the patients listed in A.3., number of patients who are both persistent and adherent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52 week anniversary from their fracture. And, separately, provide us the number of patients from A.3. where you could not obtain their adherence information at 26 weeks.
- Yes
- No
B: Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the orthopaedic inpatient ward). Our FLS enrolls only hip fracture patients.
Please refer to OC’s FLS KPIs v2.0 document for any details regarding the numbers to be reported in this audit. You may access the KPIs by copying this link into your browser: https://fls.osteoporosis.ca/indicator/
B.1. How many hip fracture patients were admitted to (or discharged from) your hospital from April 1st, 2019 to September 30, 2019? This data must be from an administrative database independent of your FLS.
B.2. From April 1, 2019 to September 30, 2019, how many fragility hip fracture patients (aged 50 and up) were newly enrolled in the FLS (i.e. first seen by the FLS coordinator) within 6 weeks of their hip fracture?
B.3. Of the patients listed in B.2. above:
B.3.a. How many were initiated (or continued) on first-line osteoporosis medication (alendronate, risedronate, zoledronic acid, denosumab or teriparatide) within 26 weeks of their hip fracture?
B.3.b. How many were not initiated a first-line osteoporosis medication within 26 weeks of their hip fractures?
B.3.c. How many are you not sure if the patient was initiated or not on osteoporosis medication within 26 weeks (e.g. patient lost to follow-up)?
B.4. How is treatment initiation ascertained for the majority (> 50%) of HIGH RISK patients in your FLS?
(Click only one answer)
- a. Our FLS provides the prescription to the patient directly.
- b. Patient self-report upon follow-up visit or phone call.
- c. Medication has been dispensed as per a pharmaceutical or administrative database. Please specify database.
- d. Other
Please provide details (if indicated):
Please provide details (if indicated):
PERSISTENCE: For the purposes of this survey, persistence is defined as documenting that the patient is still on the osteoporosis medication at 52 weeks post fracture. For patients on zoledronic acid, all patients are deemed persistent if they received their last infusion within 12-18 months prior to their 52-week anniversary from their fracture. For patients on denosumab, patients are considered persistent if no more than 7 months has occurred since their last denosumab injection at the 52-week anniversary from their fracture.
B.5. Does your FLS monitor persistence at 52 weeks post fracture?
- Yes
- No
B.5.a. If yes, we would greatly appreciate if you would be willing to share with us your FLS’s results on persistence. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on persistence?
Specifically, we will be looking for the following: Of the patients listed in 3a, number of patients who are persistent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52-week anniversary from their fracture. And, separately, provide us the number of patients from 3a where you could not obtain their persistence information at 52 weeks.
- Yes
- No
ADHERENCE: For the purpose of this survey, adherence is defined as those patients who are taking their medication as prescribed by their healthcare provider. This may vary depending on the medication. For oral bisphosphonates (alendronate/risedronate), it is defined as: Taking most of their scheduled doses (e.g. forgetting less than 20% of their scheduled doses) AND also taking their medication in a safe and effective manner (e.g. depending on the oral bisphosphonate, could include taking in the morning, on an empty stomach, etc). • For zoledronic acid, adherence is automatically ensured for 12-18 months following the first dose • For denosumab, remaining faithful with the scheduled doses (i.e. no more than 7 months between doses) • For teriparatide, taking more than 80% of their daily injections.
B.6. Does your FLS monitor adherence?
- Yes
- No
B.6.a. If yes, at what time points is this monitored?
B.6.b. Any other details regarding your monitoring of adherence:
B.6.c. If your FLS monitors adherence, we would greatly appreciate if you would be willing to share with us your FLS’s results. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on adherence?
Specifically, we will be looking for the following: Of the patients listed in 3a, number of patients who are both persistent and adherent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52-week anniversary from their fracture. And, separately, provide us the number of patients from 3a where you could not obtain their adherence information at 52 weeks.
- Yes
- No
C: Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the orthopaedic inpatient ward). Our FLS enrolls more than just hip fracture patients.
Please refer to OC’s FLS KPIs v2.0 document for any details regarding the numbers to be reported in this audit. You may access the KPIs by copying this link into your browser: https://fls.osteoporosis.ca/indicator/
C.1. How many hip fracture patients were admitted to (or discharged from) your hospital from April 1st, 2019 to September 30, 2019? This data must be from an administrative database independent of your FLS.
C.2. From April 1, 2019 to September 30, 2019, how many fragility fracture patients (aged 50 and up) were newly enrolled in the FLS (i.e. first seen by the FLS coordinator) within 6 weeks of their fracture?
a. Hip (proximal femur) fractures
b. Wrist (distal radius) fractures
c. Shoulder (proximal humerus) fractures
d. Pelvic fractures
e. Spine/vertebral fractures
C.3. Of the total non-spine fracture patients listed in 2f above, number of patients where the fracture risk was determined within 26 weeks to be:
a. HIGH RISK
b. MODERATE RISK
c. LOW RISK
d. Fracture risk could not be determined within 26 weeks
C.4. Of the HIGH RISK patients listed in C.3.a above:
C.4.a. How many were initiated (or continued) on first-line osteoporosis medication (alendronate, risedronate, zoledronic acid, denosumab or teriparatide) within 26 weeks of their fracture?
C.4.b. How many were not initiated a first-line osteoporosis medication within 26 weeks of their fractures?
C.4.c. How many are you not sure if the patient was initiated or not on osteoporosis medication within 26 weeks (e.g. patient lost to follow-up)?
C.5. How is treatment initiation ascertained for the majority (> 50%) of HIGH RISK patients in your FLS?
(Click only one answer)
- a. Our FLS provides the prescription to the patient directly.
- b. Patient self-report upon follow-up visit or phone call.
- c. Medication has been dispensed as per a pharmaceutical or administrative database. Please specify database.
- d. Other
Please specify database or other details:
Please specify database or other details:
PERSISTENCE: For the purposes of this survey, persistence is defined as documenting that the patient is still on the osteoporosis medication at 52 weeks post fracture. For patients on zoledronic acid, all patients are deemed persistent if they received their last infusion within 12-18 months prior to their 52-week anniversary from their fracture. For patients on denosumab, patients are considered persistent if no more than 7 months has occurred since their last denosumab injection at the 52-week anniversary from their fracture.
C.6. Does your FLS monitor persistence at 52 weeks post fracture?
- Yes
- No
C.6.a. If yes, we would greatly appreciate if you would be willing to share with us your FLS’s results on persistence. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest).Can we contact you in December 2019 to request your FLS’s results on persistence?
Specifically, we will be looking for the following: Of the patients listed in 3a, number of patients who are persistent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52-week anniversary from their fracture. And, separately, provide us the number of patients from 3a where you could not obtain their persistence information at 52 weeks.
- Yes
- No
ADHERENCE: For the purpose of this survey, adherence is defined as those patients who are taking their medication as prescribed by their healthcare provider. This may vary depending on the medication. For oral bisphosphonates (alendronate/risedronate), it is defined as: Taking most of their scheduled doses (e.g. forgetting less than 20% of their scheduled doses) AND also taking their medication in a safe and effective manner (e.g. depending on the oral bisphosphonate, could include taking in the morning, on an empty stomach, etc). • For zoledronic acid, adherence is automatically ensured for 12-18 months following the first dose • For denosumab, remaining faithful with the scheduled doses (i.e. no more than 7 months between doses) • For teriparatide, taking more than 80% of their daily injections.
C.7 Does your FLS monitor adherence?
- Yes
- No
C.7.a. If yes, at what time points is this monitored?
C.7.b. Any other details regarding your monitoring of adherence
C.7.c. If your FLS monitors adherence, we would greatly appreciate if you would be willing to share with us your FLS’s results. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on adherence?
Can we contact you in December 2019 to request your FLS’s results on adherence? Specifically, we will be looking for the following: Of the patients listed in 3a, number of patients who are both persistent and adherent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52-week anniversary from their fracture. And, separately, provide us the number of patients from 3a where you could not obtain their adherence information at 52 weeks.
- Yes
- No
D: Outpatient-only (i.e. the FLS coordinator first meets the patient directly in the orthopaedic outpatient clinics)
Please refer to OC’s FLS KPIs v2.0 document for any details regarding the numbers to be reported in this audit. You may access the KPIs by copying this link into your browser: https://fls.osteoporosis.ca/indicator/
D.1. How many hip fracture patients were admitted to (or discharged from) your hospital from April 1st, 2019 to September 30, 2019? This data must be from an administrative database independent of your FLS.
D.2. From April 1, 2019 to September 30, 2019, how many fragility fracture patients (aged 50 and up) were newly enrolled in the FLS (i.e. first seen by the FLS coordinator) within 12 weeks of their hip fracture and within 6 weeks for non hip fractures?
a. Hip (proximal femur) fractures (within 12 wks)
b. Wrist (distal radius) fractures (within 6 wks)
c. Shoulder (proximal humerus) fractures (within 6 wks)
d. Pelvic fractures (within 6wks)
e. Spine/vertebral fractures
D.3. Of the total non-spine fracture patients listed above, number of patients where the fracture risk was determined within 26 weeks to be:
a. HIGH RISK
b. MODERATE RISK
c. LOW RISK
d. Fracture risk could not be determined within 26 weeks
D.4. Of the HIGH RISK patients listed in 3a above,
a. How many were initiated (or continued) on first-line osteoporosis medication (alendronate, risedronate, zoledronic acid, denosumab or teriparatide) within 26 weeks of their fracture?
b. How many were not initiated a first-line osteoporosis medication within 26 weeks of their fractures?
c. How many are you not sure if the patient was initiated or not on osteoporosis medication within 26 weeks (e.g. patient lost to follow-up)?
D.5. How is treatment initiation ascertained for the majority (> 50%) of HIGH RISK patients in your FLS?
(Click only one answer)
- a. Our FLS provides the prescription to the patient directly.
- b. Patient self-report upon follow-up visit or phone call.
- c. Medication has been dispensed as per a pharmaceutical or administrative database. Please specify database.
- d. Other
Please specify database or other:
Please specify database or other:
PERSISTENCE: For the purposes of this survey, persistence is defined as documenting that the patient is still on the osteoporosis medication at 52 weeks post fracture. For patients on zoledronic acid, all patients are deemed persistent if they received their last infusion within 12-18 months prior to their 52-week anniversary from their fracture. For patients on denosumab, patients are considered persistent if no more than 7 months has occurred since their last denosumab injection at the 52-week anniversary from their fracture.
D.6. Does your FLS monitor persistence at 52 weeks post fracture?
- Yes
- No
D.6.a. If yes, we would greatly appreciate if you would be willing to share with us your FLS’s results on persistence. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on persistence?
Specifically, we will be looking for the following: Of the patients listed in 3a, number of patients who are persistent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52-week anniversary from their fracture. And, separately, provide us the number of patients from 3a where you could not obtain their persistence information at 52 weeks.
- Yes
- No
ADHERENCE: For the purpose of this survey, adherence is defined as those patients who are taking their medication as prescribed by their healthcare provider. This may vary depending on the medication. • For oral bisphosphonates (alendronate/risedronate), it is defined as: o Taking most of their scheduled doses (e.g. forgetting less than 20% of their scheduled doses) AND o Also taking their medication in a safe and effective manner (e.g. depending on the oral bisphosphonate, could include taking in the morning, on an empty stomach, etc). • For zoledronic acid, adherence is automatically ensured for 12-18 months following the first dose • For denosumab, remaining faithful with the scheduled doses (i.e. no more than 7 months between doses) • For teriparatide, taking more than 80% of their daily injections.
D.7. Does your FLS monitor adherence?
- Yes
- No
D.7.a. If yes, at what time points is this monitored?
D.7.b. Any other details regarding your monitoring of adherence:
D.7.c. If your FLS monitors adherence, we would greatly appreciate if you would be willing to share with us your FLS’s results. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on adherence?
Specifically, we will be looking for the following: Of the patients listed in 3a, number of patients who are both persistent and adherent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52-week anniversary from their fracture. And, separately, provide us the number of patients from 3a where you could not obtain their adherence information at 52 weeks.
- Yes
- No
E: Combined inpatient/outpatient FLS (i.e. the FLS coordinator does systematic and pro-active case finding both on the orthopaedic inpatient ward AND in the orthopaedic outpatient clinics).
Please refer to OC’s FLS KPIs v2.0 document for any details regarding the numbers to be reported in this audit. You may access the KPIs by copying this link into your browser: https://fls.osteoporosis.ca/indicator/
E.1. How many hip fracture patients were admitted to (or discharged from) your hospital from April 1st, 2019 to September 30, 2019? This data must be from an administrative database independent of your FLS.
E.2. From April 1, 2019 to September 30, 2019, how many fragility fracture patients (aged 50 and up) were newly enrolled in the FLS (i.e. first seen by the FLS coordinator) within 12 weeks of their hip fracture and 6 weeks of their non hip fracture?
a. Hip (proximal femur) fractures (within 12 wks)
b. Wrist (distal radius) fractures (within 6 wks)
c. Shoulder (proximal humerus) fractures (within 6 wks)
d. Pelvic fractures (within 6 wks)
e. Spine/vertebral fractures
E.3. Of the total non-spine fracture patients listed above, number of patients where the fracture risk was determined within 26 weeks to be:
a. HIGH RISK
b. MODERATE RISK
c. LOW RISK
d. Fracture risk could not be determined within 26 weeks
E.4. Of the HIGH RISK patients listed in 3a above:
a. How many were initiated (or continued) on first-line osteoporosis medication (alendronate, risedronate, zoledronic acid, denosumab or teriparatide) within 26 weeks of their fracture?
b. How many were not initiated a first-line osteoporosis medication within 26 weeks of their fractures?
c. How many are you not sure if the patient was initiated or not on osteoporosis medication within 26 weeks (e.g. patient lost to follow-up)?
E.5. How is treatment initiation ascertained for the majority (> 50%) of HIGH RISK patients in your FLS?
(Click only one answer)
- a. Our FLS provides the prescription to the patient directly.
- b. Patient self-report upon follow-up visit or phone call.
- c. Medication has been dispensed as per a pharmaceutical or administrative database. Please specify database.
- d. Other
Please specify database or other:
Please specify database or other:
PERSISTENCE: For the purposes of this survey, persistence is defined as documenting that the patient is still on the osteoporosis medication at 52 weeks post fracture. For patients on zoledronic acid, all patients are deemed persistent if they received their last infusion within 12-18 months prior to their 52-week anniversary from their fracture. For patients on denosumab, patients are considered persistent if no more than 7 months has occurred since their last denosumab injection at the 52-week anniversary from their fracture.
E.6. Does your FLS monitor persistence at 52 weeks post fracture?
- Yes
- No
E.6.a. If yes, we would greatly appreciate if you would be willing to share with us your FLS’s results on persistence. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on persistence?
Specifically, we will be looking for the following: Of the patients listed in 3a, number of patients who are persistent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52-week anniversary from their fracture. And, separately, provide us the number of patients from 3a where you could not obtain their persistence information at 52 weeks.
- Yes
- No
ADHERENCE: For the purpose of this survey, adherence is defined as those patients who are taking their medication as prescribed by their healthcare provider. This may vary depending on the medication. • For oral bisphosphonates (alendronate/risedronate), it is defined as: o Taking most of their scheduled doses (e.g. forgetting less than 20% of their scheduled doses) AND o Also taking their medication in a safe and effective manner (e.g. depending on the oral bisphosphonate, could include taking in the morning, on an empty stomach, etc). • For zoledronic acid, adherence is automatically ensured for 12-18 months following the first dose • For denosumab, remaining faithful with the scheduled doses (i.e. no more than 7 months between doses) • For teriparatide, taking more than 80% of their daily injections.
E.7. Does your FLS monitor adherence?
- Yes
- No
E.7.a. If yes, at what time points is this monitored?
E.7.b. Any other details regarding your monitoring of adherence:
E.7.c. If your FLS monitors adherence, we would greatly appreciate if you would be willing to share with us your FLS’s results. Your FLS’s one-year data on this cohort of patients is still not available (won’t be available until end of September 2019 at the earliest). Can we contact you in December 2019 to request your FLS’s results on adherence?
Specifically, we will be looking for the following: Of the patients listed in 3a, number of patients who are both persistent and adherent with first-line osteoporosis medication (include patients who are either still on same medication or switched to another medication) at the 52-week anniversary from their fracture. And, separately, provide us the number of patients from 3a where you could not obtain their adherence information at 52 weeks.
- Yes
- No

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Section 7: Information on vertebral fractures
1. How would you describe the vertebral fracture patients seen by your FLS?
(Click all that apply)
- a) Limited to acute vertebral fractures referred to/seen by orthopaedic services (inpatients and/or outpatients).
- b) Our FLS accepts spine fracture patients (acute/clinical or radiologic) by referral to our FLS, even if they are not seen by the orthopaedic service.
- c) Our FLS does spine x-rays and/or VFA on the enrolled non-spine fracture patients. Many previously undocumented spine fractures are identified with this process.
- d) Our FLS does not do routine spine x-rays and/or VFA on the enrolled non-spine fracture patients. However, we review the patient’s prior spine x-rays to see if there were any documented vertebral fractures.
- e) Our FLS does systematic and pro-active case finding of all acute vertebral fractures admitted to our hospital, whether patient is admitted to orthopaedic service or other medical services.
- f) Our FLS does systematic and pro-active case finding of all acute vertebral fractures presenting to our hospital’s emergency department.
- g) Our FLS does systematic and pro-active case finding of all acute and incidental vertebral fracture patients presenting to our hospital’s diagnostic imaging (DI) department by scanning DI reports. This includes DI reports on community patients coming in for their x-rays at our hospital’s diagnostic imaging department (e.g. a Chest x-ray ordered by the patient’s family physician to rule out pneumonia).
2. Do you give us permission to contact you for details if more information is needed?
- Yes
- No
Please provide the name of the contact person.
Email of contact person:

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Section 8: Resources and Challenges
1. Do you feel that your FLS is sufficiently resourced?
- Yes
- No
If no, please describe:
2. Please describe your FLS’s major challenges:
3. How can Osteoporosis Canada help/support your FLS?

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Section 9: Permission
Thank you for your collaboration.*
Osteoporosis Canada may use aggregate data from this audit for possible publication and/or research purposes. The individual FLS sites would remain completely anonymous in the event of any publication.
- I consent to the use of the data collected in this questionnaire for the purpose stated above.
- I do not consent to the use of the data collected in this questionnaire for the purpose stated above.

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2019 FLS Comprehensive Audit

2019 FLS Comprehensive Audit

Step 1 of 9

Section 1: Information about your FLS

FLS site information

Section 2: Staff working for your FLS

Section 3: Type of FLS

If you have clicked on 'f" above, before going any further with this questionnaire...

Section 4: FLS Processes

Section 5: Annual reporting

10. Annual FLS enrollment reporting:

Section 6: FLS Audit

A. Hip-only FLS falling under the “no dedicated FLS coordinator” exception rule.

B: Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the orthopaedic inpatient ward). Our FLS enrolls only hip fracture patients.

C: Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the orthopaedic inpatient ward). Our FLS enrolls more than just hip fracture patients.

D: Outpatient-only (i.e. the FLS coordinator first meets the patient directly in the orthopaedic outpatient clinics)

E: Combined inpatient/outpatient FLS (i.e. the FLS coordinator does systematic and pro-active case finding both on the orthopaedic inpatient ward AND in the orthopaedic outpatient clinics).

Section 7: Information on vertebral fractures

Section 8: Resources and Challenges

Section 9: Permission

2019 FLS Comprehensive Audit

Step 1 of 9

Section 1: Information about your FLS

FLS site information

Section 2: Staff working for your FLS

Section 3: Type of FLS

If you have clicked on 'f" above, before going any further with this questionnaire...

Section 4: FLS Processes

Section 5: Annual reporting

10. Annual FLS enrollment reporting:

Section 6: FLS Audit

A. Hip-only FLS falling under the “no dedicated FLS coordinator” exception rule.

B: Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the orthopaedic inpatient ward). Our FLS enrolls only hip fracture patients.

C: Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the orthopaedic inpatient ward). Our FLS enrolls more than just hip fracture patients.

D: Outpatient-only (i.e. the FLS coordinator first meets the patient directly in the orthopaedic outpatient clinics)

E: Combined inpatient/outpatient FLS (i.e. the FLS coordinator does systematic and pro-active case finding both on the orthopaedic inpatient ward AND in the orthopaedic outpatient clinics).

Section 7: Information on vertebral fractures

Section 8: Resources and Challenges

Section 9: Permission