NICE recommends earlier detection of hidden spinal fractures

The National Institute for Health and Care Excellence (NICE) has today published draft guidance recommending that a quick spinal check is added to routine bone density scans, a move it says could help identify hidden spine fractures affecting around 2.2 million people. 

NICE reports that around 70% of spinal fractures caused by osteoporosis currently go undiagnosed because they often cause no obvious symptoms. These fractures are a strong warning sign of future, more serious fractures, including hip fractures, and are linked to long-term pain, disability and loss of independence. 

Under the draft guidance, clinicians are advised to consider adding a vertebral fracture assessment to standard DXA scans for people aged 50 and over. The check takes only a few minutes and can be carried out on the same scanner during the same appointment, making it a cost-effective change that does not require new equipment. 

NICE also recommends that people with a previous hip or vertebral fracture, or with two or more fragility fractures, should automatically be offered a DXA scan without first completing a risk assessment. This removes unnecessary delay for people already known to be at high risk. 

Osteoporosis affects more than 3.5 million people in the UK and is often only diagnosed after a fracture has occurred. Each year there are around 549,000 new fragility fractures, including 86,000 vertebral fractures and more than 100,000 hip fractures. 

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

“We welcome NICE’s recommendation to add vertebral fracture assessment to routine bone scans. Vertebral fractures are common, silent and often missed, yet when left undiagnosed they cause long-term pain, disability and loss of independence, with people losing 20 working days on average. 

“This guidance will only make a difference if results lead to treatment and follow-up. That’s why it must go hand in hand with the Government’s commitment to deliver high-quality Fracture Liaison Services across the country by 2030.  If we want to protect people from a cascade of preventable fractures that work really needs to start urgently.” 

Eric Power, Interim Director of the Centre for Guidelines at NICE, said:   

"Vertebral fractures can have a devastating impact of people’s quality of life. Introducing vertebral fracture assessments during routine bone density scans will help healthcare professionals get the right care to people sooner.  

“Osteoporosis affects millions in England and this guidance will help healthcare professionals target care towards those people at highest risk, improving their quality of life while making efficient use of NHS resources." 

The guidance - which builds on recent Government investment in bone health including 13 new DXA scanners rolled out across England last year - is now open for consultation.