250,000 people per year are pointlessly exposed to harmful radiation due to bone scanning negligence in NHS

Worse-off than Romanians: UK ranks 23^rd in Europe for bone scans, Parliamentary Inquiry finds

Findings from a Parliamentary inquiry into bone density scanning published today by the Royal Osteoporosis Society (ROS) show serious and systemic failings that are leading to disability and premature death for tens of thousands of patients.

Dual energy X-ray absorptiometry (DXA) is a vital diagnostic tool for identifying people with the bone-weakening disease osteoporosis.  Early diagnosis of osteoporosis can prevent life-changing fractures, which will otherwise follow everyday occurrences like a cough, a fall from standing height or a hug from grandchildren.

Half of women over 50 will suffer fractures due to osteoporosis, and a fifth of men.  Fractures are the fourth greatest cause of disability and premature death in the UK, as well as the second greatest filler of hospital beds.  Fractures are preventable with safe, effective therapies, which are highly affordable for the NHS, but two-thirds of people with osteoporosis are missing treatment. 

The review of DXA scanning facilities has been carried out on behalf of the All Party Parliamentary Group (APPG) on Osteoporosis and Bone Health.  The Inquiry found services which are facing a chronic state of crisis, the scale of which dwarves the challenges facing CT, Ultrasound and MRI scanning following COVID-19 – one which has been decades in the making following long-term under-prioritization of bone health. 

Problems identified include:

Negligence on radiation safety

Exposure to even the lowest doses of medical radiation through scanning carries some risk to the patient, which is why strict radiation regulations require clear, actionable outputs.  Standards require that DXA scans must be accompanied by a report with personalized advice, otherwise GPs will find the scan uninterpretable – and therefore effectively useless.  A statement should also be produced defining the patient’s fracture risk, so a treatment plan can be decided upon.  Regulators also insist on regular audits of radiation-emitting scanning services for patient safety. 

A Freedom of Information request to 160 NHS Trusts and Health Boards across the UK found:

• Nearly half (47%) of services did not include personalised advice in their reports
• Nearly half (47%) of services did not include a statement defining the patient’s fracture risk
• Almost a quarter (22%) of services are not assessing their radiation safety through the prescribed audits. 

The effect of this is that around 250,000 patients per year are being exposed to radiation pointlessly since the results of scans are very unlikely to be actionable by GPs. 

Moreover, 115,000 patients every year are having scans in DXA services that are not able to assure the radiation safety of their patients. 

UK at 23^rd out of 29 European countries for scanner coverage

The number of scanners per head of population in the UK is one of the lowest in Europe – 23rd of 29 countries, beaten by Romania which has a quarter of the UK’s GDP per capita.  The international consensus is that there should be one DXA scanner per 100,000 population.  In the UK 89% of Trusts had less than one scanner per 100,000 population.  71% of Trusts had less than 0.5 scanners per 100,000 population.  This has implications for older and more vulnerable patients who struggle to travel due to mobility issues, those can’t afford travel, or those who struggle to get time off work for appointments.  For example, in Cornwall, people face a three hour round trip to get a DXA scan. 

Backlogs which are double the severity of MRI, CT and Ultrasound

Backlogs of people waiting for a DXA scan are wildly disproportionate to other imaging techniques (MRI, CT and Ultrasound).  The number of people waiting more than the prescribed six weeks for a scan has sky-rocketed nine-fold from 2,245 to 20,000 between 2020 and 2022.  Nearly half of services (46%) are missing the six week target, with a quarter of services (26%) taking more than 13 weeks.

In the weeks and months after their first fracture, patients are at high risk of suffering another, more serious, break.  Early diagnosis and medication can reduce the risk of further spinal fractures by as much as 80%.  These delays, alongside other systemic failings, are putting patients at risk of preventable, life-changing injuries.

An osteoporosis patient said: “I would say that my anxiety level started to creep up the minute that letter arrived to say that I had sustained a fracture. I’d not had an accident. How could that be possible? I was scared…

“Waiting [for a DXA scan] was hard for me. I kept waking up at night thinking ‘I’m going to die now with my broken bones. If I’ve had a rib fracture, it’s highly likely that I will have a hip fracture.

“My second DXA scan took six months. We need to do something about it. People shouldn’t have to suffer like I did.”

Since this report demonstrates clear evidence that the current DXA provision is wholly inadequate, Parliamentarians are demanding that:

• Radiation regulation enforcing authorities undertake an urgent investigation into the quality and safety of DXA provision
• Government commits immediately to revising the specification for the new Community Diagnostic Centres (CDCs) to include DXA
• NHS bodies in each of the four nations to investigate waiting times and access to DXA scanners.

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

“These systemic failings are putting tens of thousands of patients at risk of life-changing injuries which cost people their careers and, sadly in the case of many hip fracture patients, their lives. This is the result of chronic under-prioritization of bone health in the NHS, which is nonsensical since fractures are the second biggest filler of hospital beds. 

“The Government’s forthcoming Major Conditions Strategy won’t be fit-for-purpose unless it includes an actionable plan on bone health, including ensuring that DXA services are embedded in the new Community Diagnostic Centres as an early win.”

Read the full APPG report or find out more about the APPG.