Brits are living with tens of thousands of broken bones due to systemic failings, new Parliamentary Inquiry finds

Experts and Parliamentarians call for National Screening Programme for osteoporosis as findings show enormous gap in diagnosis and care

Findings from a national Inquiry published today (30 November) by the All Party Parliamentary Group (APPG) on Osteoporosis and Bone Health show major shortcomings in osteoporosis identification, treatment and care, with Parliamentarians calling on Government and the NHS to make urgent changes.

Osteoporosis is one of the most common long-term health conditions, affecting half of women and a fifth of men over 50, that causes people’s bones to weaken and break more easily. Broken bones caused by osteoporosis are not only extremely painful, they can undercut people’s independence and lead to life-changing disability. A quarter of people die within a year of suffering a hip fracture, the most serious osteoporosis-related injury.

GPs should be well placed to identify people at high risk of breaking bones before they happen, holding information about straightforward risk factors for poor bone health. But Freedom of Information data from Clinical Commissioning Groups (CCGs), Health Boards, and Trusts shows a vacuum when it comes to oversight of standards of care. The result is that opportunities for diagnosis are being routinely missed, putting people at risk of life-changing fractures. In particular:

• 74% of respondents weren’t aware what proportion of GP practices had a process for systematically identifying patients at high risk of fracture
• 90% of respondents weren’t aware if there is an identified clinician with a special interest in osteoporosis in any of their practices
• 97% of respondents did not hold information about five yearly reviews of osteoporosis treatment, despite osteoporosis having the second lowest rate of treatment adherence of any long-term condition.

The Inquiry, managed by the Royal Osteoporosis Society (ROS), was launched in February to understand why people with osteoporosis and a high risk of fracture (broken bones) are routinely being overlooked in the NHS.  

The Inquiry’s evidence shows a stark impact on the public. Patients reported feeling abandoned, with little or no monitoring or follow-up from medical professionals, as well as poor awareness of osteoporosis as a serious long-term condition. Only 48% of people were confident they were on the right medication, while 11% had to resort to private healthcare to get the tests they needed. 

Judith Cummins MP, co-chair of the APPG said:

“Primary care is the front door to the NHS. Practitioners have a wrap-around role in arranging tests to secure a timely diagnosis, getting patients onto an appropriate treatment pathway and following up to make sure patients are managing their treatment regime. But our findings show systemic failings across all three areas. The result is tens of thousands of preventable fractures, which damage lives and create enormous burdens for hospitals, ambulances and social care.

“When it comes to osteoporosis, the simple truth is that we’re spending money in the wrong place – managing the costs of failure rather than preventing harm”.  

The Inquiry’s key recommendation is for a new Osteoporosis National Screening Programme to give fracture prevention the priority it needs. Simple, cheap risk assessment tools can be used in five minutes in the GP surgery and have been proven to prevent hip fractures. Screening programmes have already been successfully implemented around other health conditions, such as bowel, breast and cervical cancer and routine tests for those at risk of diabetes, COPD, or asthma.

Currently in the UK, there is no systematic national approach to screening for osteoporosis. Instead, decisions are made by individual clinicians on a case-by-case basis, leaving thousands without the care they need – The Inquiry found that 61% of people with one of the three major risk factors for a bone health assessment had not received one.

More people die from fragility fractures caused by osteoporosis than from diabetes, yet unlike diabetes, poor bone health and osteoporosis is not included in the NHS Health Check, or any other mandated GP checks. The Inquiry’s evidence shows a programme of targeted screening for women over 70 would likely prevent 8,000 hip fractures annually.

Sunil Nedungayil, a GP practicing in the North West said:

“Systemic failings in primary care are leading to delayed diagnosis and eye-watering rates of preventable fractures. A national screening programme to pick up high fracture risk patients is a simple straightforward remedy. Once detected, we then need to make sure there are proper management systems within every primary care service to help people with their treatment.”

The recommendation for a targeted national screening programme comes alongside several other proposals, including establishing a new National Specialty Advisor for fracture prevention and osteoporosis within the NHS, broadening the range of professionals who manage patients at high risk of fracture, and defining osteoporosis as a long-term condition across all Government health guidance.

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

“For too long, fracture prevention services have been neglected, despite the prevalence of osteoporosis and the upward trend in fractures as the population ages.  Action is now beyond the point of urgency.  The postcode lottery for care and a lack of ownership for the condition is putting people at serious harm and leading to spiraling costs for the NHS”.

The report was launched at an event in Parliament on Wednesday 30 November. Read the full APPG report or find out more about the APPG Inquiry.