LETTER B – TYPE B model (2i)
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)
ÿ Vitamin D level
ÿ An x-ray of the lateral thoracic and/or lumbar spine or VFA
ÿ A BMD requisition has been filled and sent (to be done at the closest BMD center)
· Vitamin D:
ÿ Your patient is to continue with their current vitamin D supplementation (average daily dose ______IU).
ÿ Your patient was advised to take vit D 1000 IU a day (+ their current multivitamin)
ÿ Your patient was advised to take vit D 2000 IU a day (not on a multivitamin)
A referral is enclosed for your signature for the local Falls Prevention Clinic/Program.
We strongly urge you to promptly institute the following checked interventions unless there are unusual extenuating circumstances:
· 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:
As per the guidelines it is recommended that treatment with a first line therapy should be initiated promptly. See the attached table listing first line therapies with evidence for fracture prevention from Osteporosis Canada’s 2010 Guidelines.
The Provincial Pharmacare form is enclosed for your completion/signature.
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.
ÿ 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.
ÿ 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 to an osteoporosis specialist is indicated.
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, BScN, RN Dr. White, MD FRCPC/FRCSC
FLS Coordinator FLS Medical Director, Orthopaedic Surgeon or Local opinion leader