LETTER B – Type A model (3i)
Date:______
Dear Dr______,
Your patient was seen as part of the Fracture Liaison Service (FLS). Your patient presented with the following HIGH RISK situation:
a fragility fracture of the hip
a grade 2-3 fragility fracture of the spine
two or more fragility fractures since the age of 40
a fragility fracture and is on current/recent corticosteroids
a fragility fracture and the BMD test confirms the patient is deemed at HIGH RISK
Without appropriate care, this patient is at HIGH RISK for repeat fractures. All interventions and recommendations below conform to Osteoporosis Canada’s 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada (CMAJ, Oct. 2010).
The following checked items have been completed by the FLS Coordinator:
Investigations (these have been ordered with all results going to your office):
Screening blood work (calcium corrected for albumin or ionized calcium, CBC, creatinine or eGFR, alkaline phosphatase, TSH)
Serum protein electrophoresis (for spine fractures only)
Vitamin D level
An x-ray of the lateral thoracic and/or lumbar spine or VFA
A BMD requisition has been filled and sent (to be done at the closest BMD center)
Vitamin D:
Your patient is to continue with their current vitamin D supplementation (average daily dose ______IU).
Your patient was advised to take vit D 1000 IU a day (+ their current multivitamin)
Your patient was advised to take vit D 2000 IU a day (not on a multivitamin)
A referral has been initiated to the local Falls Prevention Clinic/Program.
We strongly urge you to do the following investigations:
Investigations:
A 25-hydroxy vitamin D test to be done in ______(for new starts or recent change in vitamin D dosage)
The x-rays we have ordered revealed a significant spine fracture (usually defined as >25% reduction in height). A serum protein electrophoresis is indicated
(over…)
HIGH RISK patients need effective first line osteoporosis treatment:
We have started your patient on ______. It is a first line therapy with evidence for fracture prevention (see the attached table listing first line therapies from Osteoporosis Canada’s 2010 Guidelines).
Your patient had significant issues with the medication you had prescribed. We have switched your patient to ______. It is a first line therapy with evidence for fracture prevention (see the attached table listing first line therapies from Osteoporosis Canada’s 2010 Guidelines).
The ProvincialPharmacare form has been completed and faxed.
Your patient is not taking the medication you had prescribed as ordered. We have reinforced the importance of this with your patient and we would strongly urge you to do the same to enhance the likelihood of success.
Your patient has been on treatment for less than one year. This is NOT considered failure of treatment as it typically takes 6-12 months before reduction in fracture rates is seen. Please continue with the current treatment.
Your patient has been on treatment for more than one year and is taking their medication appropriately and compliantly. As this is a new fracture, a referral has been sent to Dr. ______(local osteoporosis specialist).
We will be contacting your patient in a few weeks’ time as part of an on-going quality assurance program. We thank you for improving osteoporosis care for this fracture patient.
Sincerely,
Nurse Smith, NPDr. White, MD FRCPC/FRCSC
FLS CoordinatorFLS Medical Director, Orthopaedic Surgeon or Local opinion leader