Breaking the cycle of recurrent fracture: Scaling up a fracture prevention program in British Columbia

Low-trauma fractures (fractures that occur spontaneously or following minor trauma) are a frequent consequence of osteoporosis, leading to significant disability and even death for patients.

One low-trauma fracture often leads to a cycle of recurrent fracture. For example, half of patients who suffer a hip fracture have a history of past fracture. In BC, the cost for osteoporosis-related fractures has been estimated at $269 million for hospitals, the medical services plan, and Pharmacare alone.

Despite the availability of effective treatments that reduce future fracture risk by up to 50%, fewer than 20% of patients suffering low trauma fractures receive such treatments in their post-fracture care. This is the osteoporosis care gap.

The evidenced-based Fracture Liaison Services (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 the low-trauma fracture and seamlessly integrates secondary fracture prevention into the overall fracture experience. FLS coordinators link up with community family physicians to ensure sustainability and follow-through of the initiated interventions to prevent further fractures.

In 2012, the Secondary Fracture Prevention Research Team at Fraser Health brought together osteoporosis and fall prevention experts locally, nationally and internationally, to develop an FLS model that fit the context of the BC health care environment. In 2014, the model was implemented at Peace Arch Hospital (PAH) in BC. A controlled before and after study demonstrated a three-fold increase in appropriate fracture prevention interventions received by low trauma fracture patients in the FLS group compared to a control group. FLS is now a permanent program at PAH.

This project will explore how the FLS model implemented at one hospital in BC can be successfully adapted and scaled-up to other hospital sites within BC. The Consolidated Framework for Implementation Research will inform the implementation strategy and the RE-AIM model will frame the process and outcome evaluation. The key outcome will be to inform an FLS implementation strategy that can be used to scale up to other hospital sites across BC, improving patient quality of life after low trauma fractures and decreasing health care costs related to recurrent fractures.