Supporting an extra 1,000 patients living with osteoporosis avoid fractures

NHS Trusts across the Thames Valley, including at Oxford University Hospitals (OUH), have saved £1.5m and avoided nearly 2,000 bed days by introducing nurse-led Fracture Liaison Services.

This consistent model of support means that in just over a year an additional 1,000 patients recovering from fractures have been identified, acknowledged as ‘at risk’ for future fractures, and received treatment.

Alongside the financial savings and reduction of bed days needed, the Royal Osteoporosis Society also worked out that in the single 12-month period they looked at, 200 potential future fractures have also been avoided.

This work has been driven by the Acute Provider Collaborative, which was set up in 2023 and brings together OUH, Buckinghamshire Healthcare NHS Trust, Royal Berkshire NHS Foundation Trust and Frimley Health NHS Foundation Trust, to enhance patient care and experience.

Since its set up, it has explored good practice happening in particular Trusts and supported and enabled ways of working to be rolled out across the entire patch.

Bobby Ancil, Head of Health Services Development at the Royal Osteoporosis Society, said: "This investment in Fracture Liaison Services should be recognised and sustained as a model of excellent practice.

"Fracture Liaison Services are the gold standard for secondary fracture prevention, and evidence shows that well-resourced services reduce re-fracture risk by up to 40% while improving patient outcomes and driving long term system savings. Ongoing support and development of these services will be vital to improving bone health outcomes across the region."

Professor Kassim Javaid, Honorary Adult Rheumatology Consultant at OUH and Clinical Lead for the project, said: “A major value of this innovative integrated care system (ICS)-wide service is the rapid sharing of knowledge, skills and expertise it allows. By leveraging existing expertise within the ICS, we have ensured both consistent care delivery for all patients as well as fast tracking new Fracture Liaison Services to get set up and become effective rapidly.

"It has been inspiring seeing the nurse leadership develop and drive the Fracture Liaison Service delivery so no adult with a recent fracture is left behind."

A simple trip or fall can lead to a fracture, especially in someone over the age of 50 – often ending up in a visit to the Emergency Department or GP.

Nurses within the Fracture Liaison Service proactively look for people who have had a fracture and reach out to them to assess their osteoporosis risk.

This can involve having a DEXA scan to confirm or rule out a diagnosis and, if confirmed, organising the treatment and support needed, and following up over a 12-month period to make sure any support needed is in place.

Steve McManus, Chief Executive Officer of Royal Berkshire NHS Foundation Trust and the Acute Provider Collaborative, said: "We know that for people with osteoporosis that intervening early can make a huge difference to their outcomes, especially in the longer term.

"The nurse-led service now in place means we can spot people with the condition earlier and get them the treatment and support they need, reducing the risk of it escalating into a more serious presentation – for example a hip fracture, with all the implications that can come with that.

"Often, by small changes to lifestyle – for example by simply walking more or taking medication, we can slow the progress of any osteoporosis and allow people to carry on with life as normal."