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Fractures ‘national disgrace’

By Clare Ryan

A radical overhaul of the management of osteoporosis is recommended by a damning report cataloguing serious failings in care of patients with fractures

Most local services are providing an ‘inadequate service' with ‘unacceptable' variation in the standard of care, concluded the national audit.

The evaluation was carried out by the Royal College of Physicians on behalf of the Department of Health and the Healthcare Commission.

Among a raft of recommendations, the authors added to calls for osteoporosis to be added to the quality and outcomes framework. But it also controversially called for secondary care to take on some of the management of high-risk patients from GPs, through setting up fracture liaison services in hospitals.

Data from 157 of 173 hospital trusts found the majority of patients returning home from A&E after a fracture were not offered a falls risk assessment.

There is also concern over the number of patients referred for DXA scans. Only 4% of patients admitted to hospital with fractures had previously had a DXA scan. And just 19% of non-hip and 18% of hip fracture patients aged 65 to 74 were referred for one after their fracture.

Dr Alun Cooper, a GP in Crawley, West Sussex, who was consulted on a report for the department also recommending osteoporosis be part of the QOF, described fracture care as ‘a national disgrace'.

But he said: ‘Fracture liaison services should be based in primary care not in secondary care. It's only GPs who have access to continuity of care. Osteoporosis should be regarded as a chronic disease of which the outcome is fractures.'

But GPs feel that politics is standing in the way of making changes to the system in order to improve care.

Dr Peter Stott, a GP in Tadworth, Surrey, and member of the NOS, said: ‘There's no doubt care would improve if osteoporosis was included in the QOF. It's a very easy condition to manage, it's got very few markers. I think the problem is political.'

Dr Richard Vautrey, GPC negotiator, said: ‘We are not underestimating the concerns but this is one among many competing priorities.'

Overhauling osteoporosis care

Key findings
• Just 19% of patients with non-hip fracture and 35% of patients with hip fracture received a clinical osteoporosis risk assessment
• 96% had not had a previous DXA scan
• Only 19% of patients aged 65 to 74 with a non-hip fracture and 18% of patients with a hip fracture were referred for a DXA scan
Source: Royal College of Physicians report

• PCTs should commission a patient care pathway for the secondary prevention of falls and fractures, including a fracture liaison service
• Hospital or community-based clinics should be set up to carry out risk factor assessments
• The Department of Health should consider inclusion of osteoporosis in the QOF

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