ROS calling for better Fracture Liaison Service funding after research shows scale of ‘postcode lottery’ facing patients

New figures released by the Royal Osteoporosis Society (ROS) show the scale of the ‘postcode lottery’ facing osteoporosis patients across the country. The charity is calling on the Government to invest more in Fracture Liaison Services so that hospitals can provide patients with the expert care they need.

Fracture Liaison Services (FLS) are the key to timely diagnosis and treatment of osteoporosis, yet FLS coverage in the UK is weak, and today’s new figures reveal the full extent of the postcode lottery.

The audit, conducted via a Freedom of Information survey, sent to 123 Trusts in May, shows that only 63/123 Trusts (51%) in England were able to confirm they have an FLS. In comparison, coverage is 100% in Scotland and Northern Ireland. 

Even more worryingly, the findings show widespread under-performance in existing FLSs. Most Trusts fall consistently short of the national standards, which involve identifying and seeing at least 80% of patients in a timely way, and then following up at agreed intervals to ensure, amongst other things, that patients are supported to stay on treatment – which needs to be taken for five or more years to work.

• Only 19/123 Trusts confirmed that in 2019 they were able to identify 80%+ of their patients aged 50 years and over with a recent diagnosed fracture, and in 2020 performance declined further to just 14/123 NHS Trusts.
• Only 30/123 Trusts confirmed they see 80%+ of the patients referred to their FLS within the recommended 12-week period.
• Follow-up was also found to be poor, with only 9/123 Trusts confirming they review 80%+ of patients on osteoporosis treatment 16 weeks from fracture.
• Only 10/123 Trusts confirmed they followed up 80%+ of patients on drug treatment 52 weeks on from fracture.

The audit was launched on behalf of the All-Party Parliamentary Group (APPG) on Osteoporosis and Bone Health, which is conducting an Inquiry into healthcare inequalities facing patients.

The gaps exposed by these figures are in line with national audit data by the FLS Database, which suggests that at least 85,000 people every year are missing out on the anti-osteoporosis therapy they need. Moreover, backlogs caused by the COVID-19 pandemic are worsening delays and missed opportunities still further, with new ROS figures showing that 79% of bone-scanning services are operating at severely reduced capacity – causing daunting waits as bones deteriorate further.

The fragmented patchwork of hospital services, worst in England, means that treatable problems are routinely left to escalate, with a fifth of women suffering three or more fractures before getting a diagnosis.

The impact on people’s lives is shown by the ROS’s new patient experience data, also released today. The findings show that 38% of the 3000+ respondents had to wait over a year after their first broken bone to get diagnosed; 28% more than two years; 17% more than five years. Almost a third, 29%, of osteoporosis patients prompted their own health assessment, suggesting that thousands of less empowered patients are being left behind.

The lack of monitoring and follow-up, especially during the pandemic, has led to thousands of patients coming off their medication, putting them at risk of increasingly debilitating fractures. The ROS’s new patient experience data shows a 10pt drop in confidence amongst patients, since 2014, that they are taking the right medication (just 48%, down from 58% in 2014), with only 40% of respondents feeling confident that their medication is effective.

The Royal Osteoporosis Society is calling on Health Secretary, Sajid Javid, to use the Government’s spending review to invest in a FLS in every Trust, ensuring cover for all over 50-year-olds in the UK.

Craig Jones, Chief Executive of the Royal Osteoporosis Society, said:

“Every hour in modern Britain, people will suffer 60 broken bones due to osteoporosis – affecting mainly older people, who have already suffered so much during this pandemic. The disease has a devastating personal, societal and financial impact. It doesn’t need to be like this: levelling up services in the NHS can spare tens of thousands of people the long-term pain, disability and loss of independence caused by fractures, protecting quality of life as people live longer, and paying back the NHS’s investment many times over”.

Find out more about the APPG Inquiry.