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Spotting vertebral fractures early key to better osteoporosis care, says new guidance

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Diagnostic imaging professionals should routinely check for and report all vertebral fractures, according to new guidance, which says early identification could reduce unnecessary GP appointments and save the NHS huge amounts of time and money.

The guidance, published by the National Osteoporosis Society, said spotting vertebral fractures early would ensure many more people at risk of osteoporosis get treatment before the condition gets any worse.

“Cutting down on 13 potential extra GP visits and improving patient outcomes will have obvious benefits for local health economies”

Fizz Thompson

Written by a group of experts, including specialist nurses, it calls for fracture liaison service (FLS) pathways to be redesigned to ensure “a fail-safe alert process” for vertebral fractures, given that more than two thirds are currently undiagnosed.

Each year osteoporosis causes 500,000 broken bones and costs the NHS £1.1bn, according to the latest research evidence.

Research also suggests each vertebral fracture accounts for 14 extra GP visits in the year after it occurs, due to patients returning to their practice with pain.

As a result, early identification could free up hours of primary care time and save millions, as well as sparing patients pain and misery, according to the society.

The guidance – titled Clinical Guidance for the Effective Identification of Vertebral Fractures – includes an account from osteoporosis patient Christine Sharp.

“This new guidance from the National Osteoporosis Society seeks to address this problem head-on”

Tony Newman-Sanders

Ms Sharp said she would have been “spared a great deal of pain and suffering” if a fracture in her spine had been spotted sooner.

She said that “lack of awareness” on the part of the health professionals she saw at the time meant she was sent home from her local hospital with painkillers.

“As a result of this, I suffered more fractures in my spine – which were both devastating and life changing,” added Ms Sharp who said living with her fractures was a “nightmare that never goes away”.

Nevertheless, identifying vertebral fractures systematically has “proved challenging for all clinicians”, stated the guidance, which outlines key steps to boost timely referrals for further investigation and treatment.

Crucially, it recommended that clinicians who carry out scans and X-rays should be required to routinely check for vertebral fractures and then immediately report anything they find.

“Reporting clinicians often have the first opportunity to diagnose a patient’s vertebral fracture, which, until then, may have been asymptomatic and clinically unsuspected,” said the guidance.

“Clinicians in diagnostic imaging need to routinely examine all images showing the spine for vertebral fractures,” said the document.

“As a result of this, I suffered more fractures in my spine – which were both devastating and life changing”

Christine Sharp

It also highlighted the need to report fractures “unambiguously” using the word “fracture”, so it was crystal clear to referring clinicians that there is cause for concern.

A recent study of patients with hip fracture who also had evidence of vertebral fracture from a previous X-ray or scan found that less than half – 46% – of those fractures were reported by a radiologist at the time the image was taken.

Even fewer were acted on by the clinician that referred the patient for the scan or X-ray.

As well as beefing up reporting processes and work to identify potential cases of osteoporosis, the guidance highlights the need for extra time and resources to ensure patients are thoroughly assessed and then received the right treatment.

This might include additional clinical and bone density assessments, “as well as additional time for FLS nurses to establish whether an identified vertebral fracture is a new or old finding”.

“Similarly, establishing whether a patient with a newly identified vertebral fracture needs to be seen in the FLS will in some cases take careful consideration and additional time,” added the document.

National Osteoporosis Society

Audit finds ‘marked variability’ in NHS fracture liaison services

Fizz Thompson

The society’s clinical director, Fizz Thompson, said the guidance fitted with NHS goals to boost efficiency and “make every contact count”.

“Osteoporosis has serious and long-lasting implications for those affected, and represents a severe drain on the resources of the NHS and our already under-pressure GP services,” she said.

“Cutting down on 13 potential extra GP visits – that’s more than two hours a patient – and improving patient outcomes will have obvious benefits for local health economies,” she added.

Dr Tony Newman-Sanders, NHS England’s national clinical director for diagnostics, said the document would support diagnostic imaging professionals to identify fractures and take appropriate action.

“Vertebral fractures are the most common osteoporotic fracture, and this new guidance from the National Osteoporosis Society seeks to address this problem head-on,” he said.

He added: “This will help identify people with osteoporosis who would benefit from treatment and prevent further fractures.”

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