According to Osteoporosis Canada, as many as two million Canadians suffer from osteoporosis, a disease characterized by low bone mass and deterioration of bone tissue.As the only clinic of its kind in West Toronto, the Community Osteoporosis Program with Education (COPE) Clinic at St. Joseph’s Health Centre, Toronto, provides consultation for the prevention and treatment of osteoporosis and other metabolic bone diseases. The interprofessional team also provides support, health promotion and education for people with osteoporosis. Individuals living with osteoporosis have an increased risk of fragility fractures caused by little or no trauma, particularly of the hip, spine and wrist. Other sites of fragility fractures include the ribs, upper arm, or pelvis. “Ultimately our goal is to help people reduce their risk of fracture, as fractures are costly with a high rate of disability and mortality,” said Dr. Frances Budden. The COPE Clinic delivers care through an interprofessional team approach, with patients having access to assessment and treatment by a number of health care providers including doctors, nurses, physiotherapists, occupational therapists, social workers and dietitians. “Patients are seen in the COPE Clinic on referral from a doctor, usually because of a fracture or low bone density, measured by a DXA (dual-energy x-ray absorptiometry),” explains Dr. Budden. The initial assessment at the COPE Clinic involves a review of the person’s medical history with a physical examination. All the patients come to the Clinic with a recent DXA. Blood tests are done to rule out secondary causes of osteoporosis such as vitamin D deficiency and hyperparathyroidism. Having an interprofessional team allows the COPE Clinic to meet the many and various needs of their patients. “For example, our dietitian counsels patients on their calcium and vitamin D intake, from supplements and foods which are good sources of calcium and vitamin D and how ensuring changes and enhancements to their diet can promote their bone health. The physician recommends the daily amount of calcium and vitamin D required for bone health as well as education on the importance of exercise and falls prevention. A referral to a physiotherapist is appropriate for those who are frail with poor balance, gait impairment and at high risk of falling,” said Dr. Budden. A referral to the occupational therapist is also key to helping patients and their families remove “boobie traps” in and around the home which may contribute to another fall and risk of a broken bone. Basic nutritional advice, advocacy for exercising and guidance on healthy living for patients are also integrated into the care offered through COPE. “Exercise is important, especially for those who are getting older, because it improves balance, strength and endurance – if people are stronger and more fit, they are less likely to fall and fracture,” said Dr. Budden. Established in 1996, the Clinic sees over 1,500 patients annually. Referrals come through St. Joseph’s Emergency Department, local and distant family doctors and other subspecialists. A large number of referrals also come from our orthopaedic surgeons and the Fracture Clinic at St. Joseph’s.
Dr. George Vincent, Chief of Orthopaedic Surgery at St. Joseph’s Health Centre, believes that the majority of people diagnosed with osteoporosis can significantly reduce their risk of a major fracture when they are receiving the appropriate investigation, medications, support and education, which is all provided by the COPE team.“The Fracture Clinic and COPE Clinic go hand-in-hand,” said Dr. Vincent. “The COPE Clinic is an essential ancillary support for our patients in the Fracture Clinic who may have or are at risk for osteoporosis. The patients we care for in the Fracture Clinic have already had a fracture so it is important to determine the pathology (what underlying conditions may have contributed to the fracture) and screen for osteoporosis. Many of our patients do end up being excellent candidates for the COPE Clinic – where they will be adequately cared for – so a referral to the COPE Clinic is a natural next step for the many patients we see.” Patients are seen in the COPE Clinic on referral from a medical doctor only. If you know someone who can benefit from care through this Clinic, please call 416-530-6043 for more information or to make a referral.