University Health Network (UHN)
The UHN Fracture Liaison Service takes place at a busy fracture clinic in the Toronto Western Hospital, which is part of a hospital system that consists of four large teaching hospitals located directly in the downtown area of Toronto. The surrounding population served by the UHN includes the city of Toronto – over 2.5 million – and the fracture clinic currently sees about 30,000 patients per year. Of the patients seen in the clinic, about 60% are from Toronto and 40% from outside of the city, and about 2% are inpatients following a hip fracture. A significant portion of patients served by the clinic are immigrants, and language barrier is a common challenge that the service tackles through interpreters. The service has been running since 2013 and is led by the founding director of the Osteoporosis Program at UHN and a lead clinician, Dr. Angela Cheung. As part of the launch of the fracture liaison service at the UHN, the fracture clinic has been equipped with a DXA lab and an osteoporosis clinic, so as to serve patients with fragility fractures directly at the point of their fracture care. The fracture liaison service currently handles all fragility fractures except for vertebral fractures, because vertebral fractures are typically not seen in the fracture clinic where the service is located. The fracture liaison team is currently working on a way to identify and approach UHN patients who have vertebral fractures identified opportunistically via a chest x-ray or other types of medical imaging.