How Fracture Liaison Services could save the NHS
Every year our NHS, already operating under immense strain, faces the challenges brought by another winter.
Many people will associate this with health conditions made worse by the cold weather like asthma and ‘seasonal illnesses’ including flu and the norovirus. But unknown to many is the annual peak in hip fractures each winter and the action we should be taking to prevent them, according to the Royal Osteoporosis Society (ROS).
The latest report from the government-funded National Hip Fracture Database (NHFD) confirms an 8% increase in hip fractures during the winter months in 2018, a trend that has been consistently demonstrated by the audit. While the reasons for the winter increase are unclear, the reality is there are 2,271 more hip fractures, 325 deaths and around 45,000 more bed days at a time when the NHS least needs it.
The Conservative Party has legislated to guarantee additional funding for the NHS in its first 100 days of government, but this comes too late for those who’ll break a hip this winter. One in 13 people will die within a month of their hip fracture. More than a quarter will never return to their original residence. Around half will no longer walk independently. The majority will need support to shop, dress and go to the toilet. Their lives will never be the same again, blighted by pain, immobility, isolation and dependence on others.
“The tragedy is that around 2,500 of these winter hip fractures could have been prevented,” says Alison Doyle, Head of Operations and Clinical Practice at the ROS.
“Around 50% of people who experience a hip fracture have broken a bone in the past. Many of these fragility fractures could be prevented by timely interventions to reduce fracture risk by Fracture Liaison Services (FLS). However, the major barrier is lack of funding despite the cost savings that could be made. Over five years, an FLS would prevent around 250 fractures, saving the average CCG in England £2m for an investment of just £650,000.”
FLS was first developed in Glasgow in 1999 where clinicians noticed that patients who had broken a bone would return with another, yet underlying, osteoporosis often remained untreated by their General Practitioner. They developed a nurse-led FLS to systematically identify and treat anyone aged over 50 who had broken a bone, with the aim of reducing their risk of breaking another in the future.
Glasgow reaped the rewards of their new approach. Between 1998-2008, the city saw hip fracture reduced by 7.3% versus an almost 17% increase in England. With evidence of clinical and cost effectiveness, FLS is now the recommended model of fracture prevention across the world.
Today, every Health Board in Scotland has an FLS enabling them to offer care to 100% of the population and Northern Ireland is not far behind. Yet, in England coverage is only 53%, and in Wales 72%.
As our new Parliament sits, the Royal Osteoporosis Society calls on the Government to live up to their promises and invest in FLS now to reduce the burden of hip fractures on the NHS next winter.