Fragility Fractures

Several initiatives are under way belonging to the provincial Fragility and Stability program established by the BJH SCN, aimed at improving the bone health of Albertans. ABJHI is coordinating the work with health professionals at hospitals around Alberta while also gathering data to evaluate and report on the effectiveness of the programs.

Alberta’s care path for hip fracture surgery sets out the practices and protocols to be followed along the patient’s journey from first arriving in a hospital or clinic with a fractured hip through surgery and recovery in acute care. The hip fracture acute care path was implemented by the BJH SCN and ABJHI in 2011 and continues to be updated annually based on evidence-based oversight from a designated Clinical Committee.

ABJHI and the BJH SCN regularly gather and analyze data to help care teams monitor the care path’s performance against benchmarks. Reports flag indicators such as wait times, patient outcomes and appropriateness and effectiveness of health service delivery, which are then used by the network of care providers to inform continuous quality improvement activities. The measurement framework and patient guides are also reviewed and updated annually to reflect changes in evidence and care practices.

A care pathway for post-acute hip fracture care, otherwise known as restorative care, has also been developed which emphasizes optimal function level, quality of life and reintegration into community​. A review of the latest research and best practices is in progress to better understand current care gaps across the province.

The provincial pathways are available on the BJH SCN website: Hip Fracture Care Pathway Toolkit.

Catch a Break facilitates communication between patients who have experienced a fragility fracture and their family physicians about osteoporosis and the treatment options that exist for improving bone health. The goal is that a patient's first fragility fracture is their last. Alberta Health Services (AHS) Health Link staff use data from emergency departments and cast clinics across the province to identify Albertans over the age of 50 who had a low-trauma fracture that could be associated with osteoporosis. Patients and their family physicians receive an information package and Health Link staff contact the patients by phone. If an underlying bone weakness is suspected, the individual is invited to take part in the Catch a Break service. Health Link staff follow up with a phone call to participants at three and twelve months, as reminders to see their doctor to discuss their bone health and to learn whether participants have followed up on their doctor’s recommendations.

Beginning under the administration of the BJH SCN and ABJHI, Catch a Break became a permanent Health Link service in 2017. The BJH SCN and ABJHI continue to partner with Health Link to conduct recurring service evaluations.

Fracture Liaison Services (FLS) are designed to reduce the risk of subsequent fractures. Anyone age 50 or older who enters a participating hospital with a fractured hip is assigned a dedicated FLS team, including a registered nurse and a physician (or a team of physicians). The team does a comprehensive assessment of these patients for osteoporosis and geriatric-related medical conditions. Osteoporosis medication is initiated where appropriate and patients are referred to services, such as fall prevention and memory improvement programs, that help reduce their risk of subsequent fractures. The team tracks each patient for up to 12 months, coordinating referrals to other health professionals, ensuring patients are complying with their treatment regimen, and monitoring for medication side effects. At 12 months, management of the patient’s bone health is transferred to a family physician.

The BJH SCN and ABJHI are working to spread FLS across the province—as of September 2019, FLS operate from 10 Alberta hospitals. FLS in Alberta are certified as 3i models as outlined by Osteoporosis Canada: identification, investigation and initiation.