Article Title: Development of a Cloud-Based Application for the Fracture Liaison Service

Article Title: Development of a Cloud-Based Application for the Fracture Liaison Service

Article title: Development of a Cloud-based Application for the Fracture Liaison Service Model of Care

Authors: Christine G. Holzmueller, BLA, Simone Karp, RPh, Debbie Zeldow, MBA, David B. Lee, MPA, David A. Thompson, DNSc, MS, RN

Corresponding author: David A. Thompson, DNSc, MS, RN, Johns Hopkins Medicine, Armstrong Institute for Patient Safety and Quality;Johns Hopkins University School of Medicine, School of Nursing, and Bloomberg School of Public Health; Email:

Supplementary Table. Descriptive Data Collected for Fracture Liaison Service (FLS) Protocol

TASK / Example of Data Collected
Identify /
  • Details about fracture and hospital stay
  • Patient’s living situation and home caregivers
  • Other practitioners who treat patient (including primary care physician)
  • Height and weight
  • Patient’s ethnic and racial background
  • Patient’s primary language

Inform /
  • Bone density dual-energy x-ray absorptiometry (DXA) scan (past results and orders for future tests)
  • Lab tests: complete blood cell count (CBC), kidney function, liver function, serum calcium, 25(OH) Vitamin D
  • Documentation of communication with the physician managing the patient’s on-going care of the fracture and possible treatment for osteoporosis
  • Osteoporosis information presented to patient at time of discharge
  • Post-discharge contact with patient, including information about fracture liaison service (FLS), timing of contact, and written instructions from FLS coordinator
  • Information about falls during the previous 12 months
  • Other conditions: balance or gait problem, confusion or wandering, fear of falling, urinary incontinence, and vision problems
  • Family history of hip fracture
  • Tobacco use and smoking cessation
  • Diet and vitamin supplements
  • Alcohol intake
  • History of rheumatoid arthritis and secondary osteoporosis
  • Exercise level and tolerance
  • Menopause and kyphosis
  • Medications that might increase fracture risk
  • Past Lupron (leuprolide acetate) treatment or corticosteroid use
  • Results of Fracture Risk Assessment (FRAX)
  • Discussion and details of co-morbidities

Initiate /
  • Lab tests as described in the previous step
  • DXA scores
  • Osteoporosis diagnosis
  • Treatment options discussed and/or initiated
  • Type of treatment and medication
  • Calcium and Vitamin D recommendations
  • Patient counseling about regular weight bearing, balance, and muscle strengthening exercises; fall prevention; alcohol consumption; smoking cessation
  • Educational materials presented to patient

Investigate /
  • Medication adherence and discussion of other options
  • Status of other treatments
  • Discussion of consequences of untreated osteoporosis, fall prevention
  • Information about additional falls, or falls during the past 12 months
  • Details about a secondary fracture, if one occurred, including additional hospitalization

Iterate (follow-up) /
  • Annual creatinine, calcium, and albumin tests
  • Medication adherence and medication changes
  • Information about additional falls, or falls during the past 12 months
  • Details about a secondary fracture, if one occurred, including additional hospitalization