Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

Audit finds ‘marked variability’ in NHS fracture liaison services

  • Comment

More patients that have experienced a “fragility” fracture need access to secondary prevention through services driven by specialist fracture liaison nurses, according to a new audit.

The audit report, published on Thursday by the Royal College of Physicians, called for more trusts to set up fracture liaison services and improvements in quality at many already in place.

“We have an opportunity to close this gap in bone health care and we should work together to achieve it”

Kassim Javaid

It is the first annual review of fracture liaison services covering the identification, assessment, treatment and monitoring of patients over 50, who have experienced a fragility fracture.

The audit measured primarily against guidance and standards published by the National Institute for Health and Care Excellence and the National Osteoporosis Society.

It highlighted that fracture liaison services had been shown to be effective in preventing further fragility fractures.

But the report – titled Leading FLS improvement: Secondary fracture prevention in the NHS – found access to such services and the quality of care provided depended too much on where patients lived.

It warned that, while more fracture patients were receiving a bone health check by a fracture liaison service, a greater standard of care for all fragility fracture patients was still required.

“This new report will do a great deal to help individual NHS trusts focus on areas that will see the greatest benefit2

Fizz Thompson

This echoes estimations that implementing effective secondary fracture prevention within the NHS could help prevent over 50,000 fractures over the next five years, said the report’s authors.

Fragility fractures are those that occurs as result of normal activities, such as a fall from standing height or less. They are fractures of the large bones, generally vertebrae, neck of femur or wrist.

There are more than half a million fragility fractures in the UK each year, including around 79,000 hip fractures, at a cost to the health service of £4.3bn a year.

Patients over 50 who experience fragility fractures, the majority of whom are post-menopausal women, are more likely to go on to suffer more serious bone breaks as they age.

The Department of Health recommends that all patients who suffer a fragility fracture should have access to a local liaison service for assessment and, if required, treatment to strengthen their bones.

However, the new audit has indicated that less than half of all fracture patients were currently seen by a fracture liaison service and this also remained very variable depending on each service.

In addition, regarding waiting times, the audit found that 67% of patients were assessed by a fracture liaison service within 90 days, but this also varied widely depending on the trust involved.

“The number of older people projected to experience a hip fracture expected to rise by 65% over the next 20 years”

Kassum Javaid

Less than a quarter of fracture liaison services were able to assess over 95% of patients within 90 days and 28% of services saw less than half of patients in the same time frame.

The audit report also highlighted a “marked variability” in the proportion of patients receiving recognised standards of care.

For example, some fracture liaison services were seeing a lower number of patients than elsewhere in the country, as well as identifying less vertebral fractures than elsewhere.

However, it noted some progress, with more patients receiving a falls assessment – 40% across all fracture liaison services now compared to the previous figure of 32% from 2010.

But only 41% of patients who were prescribed anti-osteoporosis medication were monitored by 12-16 weeks post fracture. More work should be done to improve monitoring, said the report.

It also called on clinical commissioning groups and local health boards without a fracture liaison service to “actively” work with their local NHS staff to develop fund and implement one.

Royal College of Physicians

Audit finds ‘marked variability’ in NHS fracture liaison services

Kassim Javaid

Dr Kassim Javaid, clinical lead for the fracture liaison service database, on which the report is based, said: “The number of older people projected to experience a hip fracture expected to rise by 65% over the next 20 years.

“It is hugely important that patients receive effective treatment and care to help ensure they do not suffer further fractures later on in life,” he said.

He noted that being able to potentially reduce the number of preventable fractures by over 50,000 would represent a substantial fall in emergency admissions and help lessen demand on social care.

“We have an opportunity to close this gap in bone health care and we should work together to achieve it,” added Dr Javaid.

Fizz Thompson, clinical director at the National Osteoporosis Society, said: “Hip fractures caused by osteoporosis are affecting more people and costing our overstretched health service more money every year.

“The National Osteoporosis Society has long been a champion of the role fracture liaison services can play in addressing this problem,” said Ms Thompson, who has a background in nursing.

National Osteoporosis Society

Audit finds ‘marked variability’ in NHS fracture liaison services

Fizz Thompson

“This new report will do a great deal to help individual NHS trusts focus on areas that will see the greatest benefit to their patients and ensure that they provide the care and support that people with osteoporosis need,” she added.

The audit involved two expert advisors from the Royal College of Nursing – Clare Cockill, osteoporosis and fracture liaison nurse specialist, and Debbie Jannaway, consultant nurse for falls and osteoporosis and patient safety.

The report also highlighted several case studies demonstrating best practice, which cited nursing. For example, Morriston Hospital in Swansea assessed 100% of patients within 90 days of their fracture.

The fracture liaison service there was set up in January 2016 alongside a dedicated DXA reporting service. These services were “integrated under a single clinical lead and driven by a specialist fracture liaison nurse”, noted the report.

In addition, Peterborough City Hospital was picked out for assessing 96% of its patients for falls risk. It has both a fracture liaison nurse is and a falls and fracture prevention nurse.

  • Comment

Related files

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.