Osteoporosis International

, Volume 17, Issue 9, pp 1337–1345

Development of an integrated-care delivery model for post-fracture care in Ontario, Canada


    • Department of Physical TherapyUniversity of Toronto
  • C. Cameron
    • Osteoporosis Research ProgramSunnybrook & Women’s College Health Sciences Centre
  • G. A. Hawker
    • Osteoporosis Research ProgramSunnybrook & Women’s College Health Sciences Centre
  • J. Carroll
    • Ray D. Wolfe Department of Family MedicineMount Sinai Hospital
  • L. Jaakkimainen
    • Sunnybrook & Women’s College Health Sciences Centre
  • S. M. Cadarette
    • Osteoporosis Research ProgramSunnybrook & Women’s College Health Sciences Centre
  • E. R. Bogoch
    • St. Michael’s Hospital
  • H. Kreder
    • Sunnybrook & Women’s College Health Sciences Centre
  • D. Davis
    • Continuing Medical EducationUniversity of Toronto
Original Article

DOI: 10.1007/s00198-006-0076-3

Cite this article as:
Jaglal, S.B., Cameron, C., Hawker, G.A. et al. Osteoporos Int (2006) 17: 1337. doi:10.1007/s00198-006-0076-3



The purpose of this study was to develop an integrated-care model for patients at highest risk for osteoporosis, those with a low-trauma fracture. Specific objectives were to describe the current processes and patterns of post-fracture care in hospitals in Ontario; to examine health-care professional and patient awareness of osteoporosis and the roles and responsibilities of various organizations and health care professionals; and to identify barriers and facilitators and obtain feedback on the model.


In 2002, questionnaires were completed for 178 eligible hospitals.


Only 65% of hospitals inform primary-care physicians of a fracture for all patients and only 4% indicated that they provide information about osteoporosis. The main themes that emerged from the four patient focus groups (n=21) were lack of continuity of care, the absence of a link between the fracture and osteoporosis by both patients and health care providers, and need for information. Most participants agreed that something was needed to prompt their primary-care physician to investigate for osteoporosis. The four physician focus groups (n=26) identified a role for orthopaedic surgeons to flag cases.


From 34 key informant interviews with community-based organizations, we found a lack of integration between health care professionals who provide fracture care and those who provide osteoporosis management and fall prevention. Based on these data, we developed an integrated local-resource-based post-fracture care model, which we obtained feedback on at a stakeholder consultation workshop. The model focuses on improving emergency department/fracture clinic communication, emphasizes the need for follow-up investigation by family physicians for osteoporosis, and incorporates other health care professionals and a telemedicine multidisciplinary osteoporosis clinic. We are currently evaluating whether this model leads to an increase in appropriate investigation of and treatment for osteoporosis in patients with low-trauma fractures.


DiagnosisHealth servicesLow-trauma fractureOsteoporosisTreatment

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2006