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:
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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 Provincial Pharmacare 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, NP
FLS Coordinator
Dr. White, MD FRCPC/FRCSC
FLS Medical Director, Orthopaedic Surgeon or Local opinion leader