BACKGROUND AND AIMS
Osteoporosis Canada is the only organisation in Canada serving people affected by osteoporosis. The organisation works to empower, support, and educate individuals and communities on bone and muscle health and on fracture risk-reduction, with a strong focus on the spread of the Fracture Liaison Services (FLS) model of secondary fracture prevention. This presentation provides an overview of FLS development and spread across Canada, including the successes, the continuing challenges, and specific facilitators and barriers that have been identified.1
MATERIALS AND METHODS
Information to shape this presentation included: 1) data from Osteoporosis Canada’s FLS registry, audit reports, and key performance indicator development; 2) a summary report of key informant interviews with Canadian FLS leads; and 3) historical data on the development and progression of FLS in Canada since 2012.
RESULTS
Significant expansion of FLS programmes across Canada has taken place since 2012, with the number of FLS increasing from 30 in two provinces in 2012 to 55 in eight provinces in 2026. Facilitating this spread was the Brookfield Chair in Fracture Prevention (2020–2025), which provided start-up funding for new FLS, and the establishment of a national FLS medical lead to develop and sustain structured FLS processes, registries, audits, and toolkits. The context of the Canadian healthcare system poses a significant challenge to rapid and integrated FLS spread, as oversight of health is regulated by each of the 13 provinces and territories. The 2023 Osteoporosis Canada FLS National audit demonstrated high enrolment of patients with hip fracture into FLS programmes (median: 75%) and high persistence of pharmacologic treatment (median: 81%) in patients with fragility fractures who are at high risk for re-fracture. Common challenges encountered by FLS programmes include: 1) reluctance of patients to initiate anti-osteoporosis medication due to concerns about side effects; 2) lack of adequate administrative support for FLS operations; and 3) limited access to bone density testing and specialist support in rural and remote areas of the country.
CONCLUSION
Osteoporosis Canada has seen tremendous progress in improving access to FLS for Canadian patients with fragility fractures. Global collaboration and networking can help support Canada to overcome challenges and to achieve a vision where all patients receive appropriate secondary fracture prevention interventions so that no one is ‘left behind’.
