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Good fracture prevention care is not universal

50,000 fractures could be prevented over five years

Adrian O'Dowd

Thursday, 08 February 2018

Care standards for fracture patients in England and Wales to help prevent further fractures are improving but are not universally good across different locations, concludes a report published today by the Royal College of Physicians (RCP).

The Leading FLS improvement: Secondary fracture prevention in the NHS
audit report finds that while more fracture patients are receiving a bone health check by a Fracture Liaison Service (FLS) than previously, a greater standard of care for all fragility fracture patients is needed.

Currently, there are more than half a million fragility fractures in the UK each year, including around 79,000 hip fractures, which costs the NHS £4.3bn a year.

The Department of Health & Social Care recommends that all patients over the age of 50 who suffer a fragility fracture should have access to a local FLS for assessment and possible treatment.

The Fracture Liaison Services Database (FLS-DB) produced the new report, which is the first annual review of services provided by FLSs covering the identification, assessment, treatment and monitoring of people over 50, who have suffered a bone fragility fracture from a low, standing height fall.

The audit is measured primarily against NICE technology assessments and guidance on osteoporosis, and the National Osteoporosis Society clinical standards for FLSs.

The audit found that despite FLSs being an effective way to prevent further fragility fractures, access to them and the quality of care provided depended too much on where a patient lives.

It found that 67% of patients were assessed by an FLS within 90 days. This, however, varied widely depending on the NHS trust, with less than a quarter of FLSs able to assess over 95% of patients within 90 days.

Overall, there was a marked variability in the proportion of patients receiving recognised standards of care.

Some FLSs were seeing a lower number of patients than elsewhere in the country, as well as identifying less vertebral fractures than elsewhere.

More patients were receiving a falls assessment, now at 40% compared to the previous figure of 32% measured in 2010.

Less than half (41%) of patients who were prescribed anti-osteoporosis medication were monitored by 12-16 weeks post-fracture and the report recommends more work should be done to improve monitoring of fracture patients.

The authors said their findings echoed estimations that implementing effective secondary fracture prevention within the NHS could help prevent over 50,000 fractures over the next five years.

Dr Kassim Javaid, FLS-DB clinical lead said: “Fragility fractures are very common in those over the age of 50, with the number of older people projected to experience a hip fracture expected to rise by 65% over the next 20 years.

“These fractures can be a potentially life-changing experience for those who suffer them, and it is therefore hugely important that patients receive effective treatment and care to help ensure they do not suffer further fractures later on in life.

“Being able to potentially reduce the number of preventable fractures by over 50,000 would represent a substantial reduction in emergency admissions to our already overstretched hospitals and help to lessen the demand on social care at a time when these services have never been so pressured.”

Claire Severgini, National Osteoporosis Society chief executive said: “We hear far too often from people with osteoporosis about the devastating effects fractures have on their lives and their families, and it is vital that we place the prevention of fragility fractures as an absolute priority for all health services.”

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