Fracture Liaison Services – Canada

Abstract Canada, with a population of 36 million residents, has a publicly funded health-care system principally delivered by the 10 provinces and 3 territories. Each province and territory independently determines what services are medically necessary and covered by their provincial health-care system. This decentralization of health-care management and finance is a barrier to the establishment of a universal fracture prevention system. Osteoporosis Canada, the national nonprofit organisation, provides linkage, documentation, and support across the country for the development and implementation of Fracture Liaison Services (FLS). Three provinces, Ontario, Alberta, and Nova Scotia, have provincially funded FLS. Separate initiatives have established FLS programs in British Columbia, Ontario, and Quebec. The key challenge for improvement of fracture prevention in Canada is to advocate for and establish high-functioning FLS programmes throughout all 13 health-care jurisdictions and have health ministries require hospital performance in this area in their funding models. There are notable positive features evident in some Canadian FLS programmes, beyond the essential elements shared by FLS programmes in general. The Canadian FLS experience has permitted us to see the importance of the iterative improvement processes, focused data collection to enable process evaluation and outcome assessment, adaptability to local conditions, the importance of the coordinator/FLS nurse role, gender equality achieved through two Canadian FLS Programmes, and the FLS as an engine for education and the importance of the patient's knowledge, perceptions, and attitudes.