Tackling osteoporosis -the silent disease

Ahead of November’s National Osteoporosis Society Conference, Tim Jones, Commissioning Advisor for the National Osteoporosis Society, looks at what can be done to address the rising problem

This summer, the charity I work for – the National Osteoporosis Society – celebrated its 30th anniversary.

Founded in 1986, it was established to raise awareness of the bone condition, which at the time was little understood and a long way down the list in terms of awareness for the general public and the health professionals they may have called on for help and advice.

Thirty years on and, thankfully, the situation has changed in terms of recognition of osteoporosis and, thanks in part to the work of charity, of a better understanding of the needs of those affected by condition among GPs and health professionals.

But there is still more to be done. More than 3 million people in the UK are estimated to have osteoporosis and every year, people in the country suffer more than 300,000 fractures – that’s one every two minutes. One in every two women and one in every five men over the age of 50 are expected to break a bone during their lifetime.

The consequences of this are far-reaching. A month after suffering a hip fracture, one in 13 people will have died and only half will have returned home from hospital. Then there’s the wider financial impact: the cost of hospital care for a patient with fractures excluding the cost of social care is more than £1.9 billion a year.

So osteoporosis is still a significant problem. However, prompt identification and management following the first fracture presents a great opportunity to reduce the risk of a second fracture. This is why the National Osteoporosis Society has been focusing its work on Fracture Liaison Services (FLS). FLS systematically identifies, treats, follows up and refers all eligible patients aged over 50 years within a local population who have suffered a fragility fracture, with the aim of reducing their risk of subsequent fractures.

In a landmark study over 10 years, the Glasgow FLS assessed more than 50,000 fracture patients. During this period, hip fracture rates in Glasgow reduced by 7.3% versus an almost 17% increase in England. Also, evaluation by the Department of Health of the service in Ipswich has shown that FLS can be highly cost effective. When the National Osteoporosis Society made establishing and improving FLS a priority for three years, it was imperative that the current situation, challenges and opportunities were discovered and discussed.

A multidisciplinary implementation group was set up, which included representatives from NHS England and Public Health England, to lead the project. From here the FLS resources were planned and developed. These include the FLS toolkit, which cuts down the work needed to get a service up and running. Central to this is the charity’s ‘benefits calculator’, which uses population, case study and empirical data to show local commissioners the reduction in fracture numbers and costs that should result from implementing a service.

As more data is published on the effectiveness of FLS, so this tool will become ever better, but right now it’s the best way to demonstrate how much money might be saved if an FLS is implemented.

Other tools in our bag for the busy team at the hospital include face-to-face workshops to learn the language of commissioners so that the business case is approved first time. Our approach is working as we are currently in conversation with more than 40 established or potential new FLS across the UK, with the number growing daily.

Recent studies from Australia and the Netherlands have shown that hospitals that have introduced FLS show lower rates of hip and other fractures compared to those that have no service, with the benefit starting about a year and a half from the service start. The Society is carrying out a similar study of hospitals in the UK which is showing a similar effect – we will be publishing the results later this autumn, so watch this space.

[First published September 2016]