Breaking the cycle of recurrent fractures: 2019 Implementation Science Team Project Grant Recipient

After rigorous peer review, the Michael Smith Foundation for Health Research (MSFHR) recently awarded the Fraser Health Authority team in British Columbia (BC), a three-year project team grant worth $500,000. The project, titled “Breaking the cycle of recurrent fracture: Scaling up a secondary fracture prevention program in Fraser Health to inform spread across British Columbia”, is co-led by Dr. Sonia Singh (Fraser Health clinician-researcher,) Larry Funnell (Patient partner researcher) and Dr. Tania Bubela (Simon Fraser University, Dean of Health Sciences). This project may well be the tipping point for Fracture Liaison Service (FLS) implementation in BC. This project will explore how the FLS model implemented at the Peace Arch Hospital (White Rock) in Fraser Health can be successfully adapted and scaled-up to other hospital sites within the health authority.

This leading-edge project aligns with the mandate of Osteoporosis Canada in supporting nation-wide implementation of effective secondary fracture prevention. One key expected outcome is to inform an FLS implementation strategy that can be used to spread the FLS model across BC, thereby improving patients’ quality of life after low-trauma fractures and decreasing health care costs related to recurrent fractures. The research findings from this project may result in dramatically improved access to appropriate osteoporosis care for fracture patients in BC and will impact future program planning of secondary fracture prevention across Canada.

Key Performance Indicators (KPIs)

Osteoporosis Canada (OC) is pleased to announce the updated version of “Key performance indicators (KPIs) for Canadian FLSs (v2.0)”. Version 2 of the OC FLS KPIs brings in new learnings from OC’s first national audit released in September 2018.

The FLS KPIs provide:

  • A way to measure the performance of the FLS at the level of the system
  • A useful tool to facilitate on-going continuous quality improvement through Plan-Do-Study-Act (PDSA) methodology to address any identified care gaps
  • The ability for FLSs to compare their performance with that of other FLSs from across Canada

Canadian FLSs will be using KPI (Version 2.0) when participating in the next national FLS audit later in 2019.

The OC KPIs are a critical tool for the measurement and monitoring of the FLS’s effectiveness and will allow Canadian FLSs the opportunity to reach their full potential. Osteoporosis Canada’s goal is to ensure that no fragility fracture patient is “left behind” and that every Canadian has access to appropriate post-fracture care.

To view the complete English KPI document, please click here.

To view the complete French KPI document, please click here.  

Congratulations to Fraser Health’s Fracture Liaison Service team!

A development grant to improve osteoporosis care for fragility fracture patients has been awarded to British Columbia’s Fraser Health Authority. Funding for “Breaking The Cycle Of Recurrent Fracture: Scaling Up A Fracture Prevention Program In British Columbia” was awarded by the Michel Smith Foundation for Health Research.
Osteoporosis Canada congratulates the project co-leads, Dr. Sonia Singh (FLS Medical Lead, Peace Arch Hospital, Fraser Health), Larry Funnell (patient partner), Tania Bubela (Dean of Health Sciences, Simon Fraser University), and Teresa O’Callaghan (executive sponsor, Executive Director Peace Arch Hospital, Fraser Health) and all their team members.
This project will explore how the Fracture Liaison Service (FLS) model implemented at one hospital in BC (Peace Arch Hospital, White Rock) can be successfully adapted and scaled-up to other hospital sites to break the cycle of recurrent fractures.
The evidenced-based FLS model has been recognized and adopted worldwide as the most effective model for preventing recurrent osteoporosis-related fractures in a cost-effective manner. FLS involves a dedicated coordinator who “captures” the patient at the point of orthopedic care for low-trauma fracture and seamlessly integrates secondary fracture prevention into the overall fracture experience. FLS coordinators link up with community family physicians to ensure on-going care and follow-through of the initiated interventions to prevent further fractures.
The Michael Smith Foundation development grant was one of 10 projects chosen in a provincial competition for Implementation Science Research. The Fraser Health team now goes on to the next stage of the competition which is to develop a full grant proposal to roll out Fracture Liaison Service (FLS) at multiple sites in Fraser Health and evaluate implementation over three years. Five projects will be funded in June 2019.
Given the great need for more FLSs, Osteoporosis Canada wishes the team every success with the next round of the competition and increasing uptake of FLS in British Columbia.

Osteoporosis Canada’s first national FLS audit

The results from Osteoporosis Canada’s first national FLS audit demonstrate the positive impact of Canadian FLSs on the lives of fragility fracture patients. The promising results, released in September 2018, are included in the “Report from Canada’s first national FLS audit” which provides an overview of the audit for the cohort of patients enrolled in Canadian FLSs between April 1 and September 30, 2017.

The huge post-fracture care gap has been well documented in many Canadian jurisdictions.  Without FLS, less than 25% of fragility fracture patients will be diagnosed and/or treated for their underlying osteoporosis.

By significantly improving osteoporosis care, FLSs help prevent future fractures, reduce patient suffering and increase their independence. With less than 50 FLSs in Canada, many more FLSs are needed to provide appropriate care to fracture patients.

To read the full report, please click here.

Osteoporosis Canada to Launch New FLS Registry

Osteoporosis Canada (OC) is excited to announce the upcoming launch of the OC FLS Registry. The OC FLS Registry will be an online map profiling FLS programs across Canada, which meet OC’s Essential Elements of Fracture Liaison Services. The Registry will allow insight into the breadth and location of FLS across the country. It will serve as a vital tool to assist with OC’s efforts to foster the implementation of effective FLS across Canada.

Submissions to the OC FLS Registry:

OC is now accepting submissions for the upcoming launch of the Registry. FLS programs across Canada are invited to submit their program for profile in the Registry. Submissions are open to all FLS programs currently in operation, from those who have newly opened to established programs. Submission forms can be found here.

Submissions received on a rolling basis and the Registry will be updated regularly throughout the year.

For more information, read our FAQ and/or email Katie Cvitkovitch, Manager of FLS with Osteoporosis Canada at

Do you know of an FLS program currently in operation in Canada? Please share this link and encourage them to make a submission.


About FLS:

A Fracture Liaison Service (FLS) is a specific system-based model of care for secondary fracture prevention where a dedicated coordinator:

  • systematically and proactively identifies patients aged 50 years and older presenting to a hospital with a new fragility fracture and/or with a newly reported vertebral fracture;
  • organizes appropriate investigations to determine the patient’s fracture risk;
  • facilitates the initiation of appropriate osteoporosis medications.


Quality Standards for FLS in Canada Document Receives Additional Endorsements

Osteoporosis Canada’s Quality Standards for Fracture Liaison Services in Canada were developed to support implementation of effective FLS. They provide clear guidance for healthcare professionals and administrators on what an effective FLS will deliver, and assurance that the FLS can be set up for success at the time of implementation.

To date, the Quality Standards have been endorsed both nationally and internationally by:

The Canadian Orthopaedic Association The Canadian Orthopaedic Nurses Association
Bone and Joint Canada The Canadian Rheumatology Association
SIGMA Canadian Menopause Society The Canadian Falls Prevention Education Collaborative
International Society for Clinical Densitometry The Canadian Geriatrics Society

Download a copy of the Quality Standards for Fracture Liaison Services in Canada here.

Osteoporosis Canada Applauds the BC Government for Supporting Falls and Fracture Prevention

Minister Terry Lake, the Minster of Health in BC, has announced a grant for programs to help prevent falls and hip fractures in older adults and enhance mobility through early intervention.

This announcement comes on the tails of an MLA lunch which was hosted by Osteoporosis Canada on October 27th, in Victoria, BC.  The session focused on the osteoporosis care gap and the need for FLS programming in BC.
Click here to read the full press release.

Sun Life Financial donates more than $100,000 to the Fracture Navigator Program, Dartmouth, N.S.

On May 25, 2012 Sun Life Financial announced a donation of $ 103,232 to the Fracture Navigator Program, led by Dr. Diane Theriault at the Dartmouth General Hospital in Nova Scotia. For patients with osteoporosis in the community, this program will help reduce future medical complications, including repeat fractures, through early diagnosis and appropriate treatment.

“One of the priority areas for Sun Life’s philanthropy program is health-related initiatives, especially those that promote wellness or prevention,” said Scott Woodman, Regional Vice-President, Atlantic Region, Sun Life Financial Canada. “We’re proud to partner with the hospital to be part of the Fracture Navigator Program, which can make a real difference for many people in our community.”


Sun Life Financial Donates More Than $100,000 to Dr. Diane Therialt's Fracture Navigator Program

From left to right: Scott Woodman, Regional Vice-President, Atlantic Region, Sun Life Financial Canada; Michael Wild, Advisor, Sun Life Financial Canada; Kim Conrad, Chair, Dartmouth General Hospital Charitable Foundation; Dr. Diane Thériault, Medical Director, Dartmouth General Hospital Fracture Navigator Program.

A whitepaper titled Towards a Fracture-Free Future; published by Osteoporosis Canada in March 2011 highlights the need for effective screening and post fracture care strategies for the identification and treatment of high risk fracture patients. In simple terms, once an individual has broken a bone due to osteoporosis, they are much more likely to break again – making them high risk. While our current medical system is geared to provide effective care for such fracture patients; over 80% of these patients are never offered assessment and/ or treatment of their underlying osteoporosis. They just fall through the cracks in the current health care system and remain at risk for recurrent, debilitating and life threatening osteoporotic fractures. The Fracture Navigator program bridges that very gap in the health care system for the residents of Dartmouth, N.S.

Osteoporosis Canada applauds the efforts of Sun Life Financial Canada in helping close the care gap. With their generous support, the Fracture Navigator program will help to effectively identify and manage these patients- so that their first fracture will be their last.