Variation in missed opportunities for secondary fracture prevention.

Abstract

Introduction Despite clear national guidelines and government support for Fracture Liaison Services, the osteoporosis treatment gap remains significant. The Fracture Liaison Service Database (FLS-DB), a national audit run by the Royal College of Physicians (RCP), has recently expanded its reporting to highlight this issue. Method Previously the FLS-DB benchmarked data from those trusts submitting data to the audit. From January 2025, an extra column has been added to show ‘Missed Opportunities’ that includes data from sites not participating in the FLS-DB. Using local hip fracture data for 2022 from the National Hip Fracture Database (NHFD) figures, the predicted local FLS caseload was determined by multiplying the number of hip fractures by 5. Expecting 80% of the predicted caseload to be identified, at least 50% of those to be recommended treatment (accounting for mortality, severe comorbidities etc.) and 80% of those initiating and staying on treatment up to 12 months gives the expected on treatment population. This was compared with the data from the FLS-DB and NHFD KPI set to generate the number with a missed opportunity. Results 77 FLS are participating with the FLS-DB with 82 NHFD sites not covered by an FLS. While 80,767 records were submitted in 2022, the missed opportunity count was estimated to be 56,550 patients (48,214 in England and 6180 in Wales) per annum. When the missed opportunity estimate was analysed in 36 ICSs, there was an over 100-fold difference in the estimate. Conclusions Despite clear guidelines and prioritisation of FLSs, over 50,000 patients are not on osteoporosis treatment when they should be. By making this data visible at the local hospital and ICS/Health board level, care providers can better judge the level of resources required for FLS locally, and the data provides support for ICSs in FLS implementation.