FLS REGISTRY: Spotlight on St. Michael’s Hospital, Osteoporosis Exemplary Care Program (OECP)

The Osteoporosis Exemplary Care Program (OECP) at St. Michael’s

Hospital in Toronto, Ontario has been a leader in the FLS movement in Canada and worldwide. OECP was founded in 2002 by Dr. Earl Bogoch, orthopaedic surgeon at St. Michael’s Hospital in Toronto, and was the first FLS in Canada.

Under Dr. Bogoch’s leadership, the OECP/FLS at St. Michael’s is dedicated to closing the post-fracture care gap.  The FLS manages 350 to 450 fracture patients annually.

The key features of identification, investigation and initiation of treatment, commonly referred to as the “3 i’s of FLS”, are an integral part of the OECP.  The OECP coordinator proactively identifies patients who present to the hospital’s inpatient ward and outpatient fracture clinics with a fragility fracture. The coordinator then investigates, through bone mineral density (BMD) testing and assessing risk factors, to determine the patient’s future fracture risk and provides education on nutrition and fracture risk reduction strategies.  Where appropriate, the FLS coordinator refers the patient to an osteoporosis specialist or back to their primary care provider (PCP) to ensure appropriate treatment is initiated.

The OECP has demonstrated success at capturing patients at risk for future fractures and initiating testing and treatment to help prevent them.¹ The OECP also undergoes iterative modifications and improvements based on program performance outcomes and qualitative study results.

As reported at the American Society of Bone and Mineral Research Annual Meeting in Atlanta in September 2016, data from December 2010 to November 2013 revealed that 94% of high risk, treatment naïve fragility fracture patients were assessed by a specialist or a primary care physician; 70% were prescribed/recommended pharmacotherapy in addition to calcium and vitamin D.² These findings are significant for this patient population where typically less than 20% ever receive osteoporosis treatment without an FLS.^3-5

A cost-effectiveness analysis⁶ of the OECP, conducted after implementation of the program, demonstrated a high probability of cost-effectiveness of this intervention from the hospital cost perspective.Other economic evaluations done in Canada also demonstrate cost effectiveness of fracture prevention programs.^6-8

St. Michael’s OECP has also informed much of the work behind the Ontario Osteoporosis Strategy FLS.

The OECP is featured on Osteoporosis Canada’s online FLS Registry. Each of the FLSs showcased on the Registry has demonstrated a commitment to the principles of identification, investigation and initiation of treatment which will ensure fracture patients receive the care they need to help prevent future fractures. View the FLS Registry now at https://fls.osteoporosis.ca/fls-tools-and-resources/fls-registry-map

1. Bogoch ER, Elliot-Gibson V, Beaton DE, Jamal SA, Josse RG, Murray TM. Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment. J Bone Joint Surg Am. 2006;88(1):25-34.
2. Bogoch E, Elliot-Gibson V, Beaton D, Josse R, Sale J, Norris E. 2016 Fracture Risk Specific Treatment Initiation Rates in an Orthopaedic Fracture Liaison Service. J Bone Miner Res 30 (Suppl 1). Available at http://www.asbmr.org/Itinerary/PresentationDetail.aspx?id=b616afc3-069c-4a24-8979-5f12b2e8389f Accessed September 8, 2016.
3. Papaioannou A, Giangregorio L, Kvern B, Boulos P, Ioannidis G, Adachi JD. The osteoporosis care gap in Canada. BMC Musculoskelet Disord. Apr 6 2004;5:11.
4. Papaioannou A, Kennedy CC, Ioannidis G, et al. The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study. Osteoporos Int. Apr 2008;19(4):581-587.
5. Bessette L, Ste-Marie LG, Jean S, et al. The care gap in diagnosis and treatment of women with a fragility fracture. Osteoporos Int. Jan 2008;19(1):79-86.
6. Sander B, Elliot-Gibson V, Beaton DE, Bogoch ER, Maetzel A. A coordinator program in post-fracture osteoporosis management improves outcomes and saves costs. J Bone Joint Surg Am. Jun 2008;90(6):1197-1205.
7. Yong JH, Masucci L, Hoch JS, Sujic R, Beaton D. Cost-effectiveness of a fracture liaison service-a real-world evaluation after 6 years of service provision. Osteoporos Int. 2016 Jan;27(1):231-40.
8. Majumdar SR, Lier DA, Beaupre LA, Hanley DA, Maksymowych WP, Juby AG, Bell NR, MorrishDW. Osteoporosis case manager for patients with hip fractures: results of a cost-effectiveness analysis conducted alongside a randomized trial. Arch Intern Med. 2009 Jan;169(1):25-31.