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Thu, 9 April 2020

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Healthcare inequity increases risk of dying from fractures and broken bones

Healthcare inequity increases risk of dying from fractures and broken bones

Royal Osteoporosis Society

3 min read Member content

We need systematic changes to how fractures are treated to prevent healthcare inequalities that exist when it comes to getting access to a fracture liaison service, says the Royal Osteoporosis Society. 

Healthcare inequality is again under the spotlight, with a new report by Professor Sir Michael Marmot finding that life expectancy has declined among the poorest women. 

As a charity working to prevent the devastating fractures and broken bones that can dramatically reduce quality of life and life expectancy, we have long understood the relationship between austerity and mortality rates. Hip fractures, which resulted in over 4,000 deaths last year, are 17% more likely to be experienced by the most deprived women in society, compared to the most affluent, while the least deprived men are 50% more likely to experience this potentially life-threatening injury. 

Hip fractures are experienced by over 66,000 people a year and take up one in 45 hospital beds in England and Northern Ireland, and one in 33 beds in Wales. They are preventable when the less traumatic fractures that precede them, such as fractures to the wrist, are promptly acted on and people with osteoporosis are provided with bone protecting treatment. 

It’s therefore deeply concerning that healthcare inequalities across the country mean that, while everyone living in Scotland and Northern Ireland has access to a fracture liaison service (FLS) to reduce the risk of them experiencing a hip fracture, people in England and Wales are not so fortunate. The result is that in areas where there is no FLS, hospitals continue to experience higher-than-average mortality rates for patients who have sustained hip fractures. 

Questions tabled in the House of Lords by Baroness Bull will call for the government to state if it is committed to achieving 100% FLS coverage across England and Wales. They will also ask what other indicators are in place to ensure that someone who is at high risk of breaking bones is being acted upon. Such indicators include whether the individual has suffered a vertebral fracture, two-thirds of which currently go undiagnosed. 

Better identification of these fractures represents a significant opportunity to improve healthcare outcomes. Not only are they associated with an eight-fold increase in age-adjusted mortality, but they are also highly predictive of hip fractures and timely treatment can reduce the risk of further fracture by 50-70% in just six to 12 months. 

Vertebral fractures are, however, difficult to diagnose, with individuals affected typically visiting their GP 14 times, due to unidentified back pain, before they get a diagnosis. This in itself puts additional pressure on primary health services. 

A practicable solution is to ensure that radiologists who typically notice these vertebral fractures while evaluating scans and x-rays on patients for other conditions, but fail to report them as being not relevant, be upskilled to recognise the risks that vertebral fractures present and their role in preventing them. 

To this end, the Royal Osteoporosis Society is working with Health Education England to launch e-Learning for Healthcare training modules aimed at embedding clinical guidelines for identifying vertebral fractures into current practice. 

In addition, we are also calling for systematic changes to how the fragility fractures that take place once every minute in the UK are treated, to prevent the healthcare inequalities that currently exist when it comes to getting access to a fracture liaison service. 


For more information about our work to increase diagnosis and treatment of vertebral fractures, please contact 


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