This quality improvement program focuses on secondary fracture prevention by identifying patients at risk for future fracture and initiating appropriate evaluation, risk assessment, education, and therapeutic intervention. From inception, data collection and analysis have been central to the program, and approval by the Research Ethics Board was obtained to permit the publication of quality assurance data.  The program undergoes regular iterative program modifications based on evolving risk assessment tools and treatment guidelines, performance outcomes, and qualitative study results.

Data collection has allowed publication related to program development, outcomes, cost-effectiveness, and patient perceptions as the program has a research function in publishing progress in Fracture Prevention methods. The St. Michael’s team works closely with the researchers and analysts of the Fracture Screening and Prevention Program (FSPP), a secondary fracture prevention program of the Ontario Osteoporosis Strategy (OOS), to analyze data from the program. Publications have been included in the leading journals in orthopaedics, such as the Journal of Bone and Joint Surgery, and osteoporosis, such as Osteoporosis International with presentations provincially, nationally, and internationally. The work is also included in numerous book chapters in Fracture Prevention in Canada and post-fracture care.

All University of Toronto orthopaedic residents receive training in post-fracture care. It is a goal of the program to share the model with past residents and fellows, researchers, and physicians around the globe so they can start their own FLS program.

The work at SMH was a key exemplar that led to the development of the Ontario Osteoporosis Strategy (OOS), Fracture Prevention and Screening Program in 2006. Training of the Ontario Fracture Prevention Coordinators at St. Michael Hospital continues as well as continued work with Osteoporosis Canada’s OOS and has resulted in numerous publications on the provincial-wide program.

In 2020, Dr. Bogoch was appointed the inaugural holder of the Brookfield Chair in Fracture Prevention – a global first of its type. The Chair has several goals, but its key clinical goal is facilitating the establishment of Fracture Liaison Services in the 80% of Canadian hospitals where none exists.

The SMH FLS is listed on Osteoporosis Canada FLS Registry and the International Osteoporosis Foundation’s Capture the Fracture Initiative. SMH FLS continues to meet Osteoporosis Canada’s Essential Elements of an FLS. This trend-setting program has been guiding and inspiring clinicians to establish programs at other hospitals and creating a gradual expansion of access to this exemplary care program for Canadians who suffer a fragility fracture. Thank you and congratulations to St. Mike’s for the previous 20 years and we look forward to future decades of celebrating this service.