What is a Fracture Liaison Service?

The first sign of osteoporosis is often a fracture (broken bone). Our bones are living structures that constantly renew themselves throughout our lives- this is called bone turnover. In people with osteoporosis this bone turnover becomes out of balance, causing bones to lose strength and become more fragile. As a result, bones can break more easily, sometimes after a minor bump or fall, which can have a huge impact on people’s daily lives.

Although there are many risk factors for osteoporosis, people who already have a fracture due to the condition can be at a greater risk of further fractures if the underlying osteoporosis isn’t treated.

This doesn’t have to be the case though. Fracture Liaison Services (FLS), which are the gold standard for fracture care, play an important role in identifying, assessing and treating osteoporosis in people over the age of 50 with a fracture. Improved access to DXA (dual energy x-ray absorptiometry) scanning, which measures bone density, and support around drug treatments through an FLS can help to reduce the risk of further fractures.

In most cases patients are referred to, or are identified by, a FLS, which can be based at a doctor’s surgery or more commonly a hospital. There patients will be assessed and receive support from a nurse, or a doctor with expertise in osteoporosis and fracture prevention.

However, in England and Wales, only half (51%) of NHS trusts have an FLS, compared to 100% coverage in Scotland and Northern Ireland. We spoke to Jan Westbury about her experience of diagnosis and treatment in an area without access to an FLS.

Jan’s perspective
“In 2012 I fractured both my arms when I fell backwards. The healthcare professionals who cared for me did not mention that I could have low bone density and there was no mention of a Fracture Liaison Service.

“A few days later my GP saw the x-ray reports and thought it looked like I’d had fragility fractures and so arranged a DXA scan. The results found that I had osteopenia in both my hips – meaning my bone density was lower than the average adult, but not low enough to be diagnosed as osteoporosis.

“Since then, I’ve sustained a neck injury which took me two years to recover from and also sudden severe onset of sciatica that was a challenge for 18 months. At each point my osteopenia has been dismissed as a cause.

Jan was due to have her next scheduled DXA scan in 2020, and although this was delayed due to COVID-19, she discovered that scans are no longer routinely carried out in her area.

“Obviously for me, I am wondering if there is any deterioration in my bone density, which could mean a delay in treatment.

“Fracture Liaison Services are absolutely essential for early detection and treatment of low bone density and prevention of further deterioration.

“The postcode lottery for a Fracture Liaison Service means that I and many others miss out on access to proper co-ordinated care and expert advice. I believe my local hospital still does not have an FLS.”

Ending the postcode lottery for FLS
Osteoporosis currently affects 3.5 million people in the UK. When the condition is diagnosed early, osteoporosis is easily treatable and patients can go on to live ordinary lives. Without early diagnosis or treatment, the risk of fracture and their effect is more likely to escalate. Fracture Liaison Services are the way to ensure everyone has access to the care they need.

In March last year, the All Party Parliamentary Group (APPG) on Osteoporosis and Bone Health was launched to raise awareness of the importance of bone health and the potentially devastating impact of the condition, amongst Parliamentarians and NHS leaders.

As its first act, the APPG launched an inquiry into FLS provision in the UK which demonstrated the scale of under-diagnosis, along with its recommendations for change. When the APPG meets again in February this year, it will be building on this momentum to launch its 2022 inquiry into primary care, the first point of contact in the healthcare system. The aim is to end the postcode lottery around osteoporosis to improve the experiences of people living with osteoporosis across the UK.

More information and support
If you’d like to find out more about how osteoporosis is diagnosed, visit: https://theros.org.uk/information-and-support/osteoporosis/newly-diagnosed/video-2-how-is-osteoporosis-diagnosed/

For information and support tailored to you call the free Helpline on 0808 800 0035 or email nurses@theros.org.uk

To find out more about our campaign work, visit: https://theros.org.uk/how-you-can-help/campaign-with-us/