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Systematic failures in osteoporosis care

By Emma Wilkinson

A failure to invest in GP osteoporosis care has brought systematic failures in implementing best practice, a major new audit of half a million patients concludes.

The audit, the largest-ever in UK primary care, found only one in nine high-risk patients was assessed and treated in line with current guidance.

But the proportion treated was far higher in areas where GPs had been resourced for case-finding – illustrating the corrosive effects of years of under-funding elsewhere.

Experts said the figures highlighted the urgent need for resources and criticised the Government's failure to deliver on its promise to improve diagnostic facilities.

They warned that of £20 million promised for DEXA scanning, only £3 million had so far been made available, and this was only for machines, not staff.

Study leader Dr Jonathan Bayly, clinical lead for the Gloucestershire Primary and Community Care Audit Group, which conducted the audit, said: 'It's been a blind spot. Osteoporosis interventions reduce fractures by 50 per cent. Four million bed days a year are a result of falls. It's the elephant in the room.'

Dr Bayly, associate lecturer in osteoporosis at the University of Derby, added: 'We need a systematic approach. QOF would lead to an astronomical improvement in standards.'

Prevalence of patients at high-risk of fractures was only a third of that expected, suggesting only a minority were being identified. Of these, the proportion treated varied from 47 per cent in practices which had been funded for case-finding to 28 per cent in those which had not.

The audit also found fewer than a third of elderly patients in a nursing home or residential care had been assessed

for osteoporosis or prescribed calcium/vitamin D3.

And only 31 per cent of the over-75s at risk of falls had been referred to a falls service.

Dr Peter Stott, member of the primary care forum for the National Osteoporosis Society and a GP in Tadworth, Surrey, said there were failures in care throughout the NHS. 'It's a problem with the whole pathway. It's frustrating because there's a very strong evidence base and it needs to be in the QOF. It's a lot of work, akin to asthma or hypertension.'

Priorities for general practice

• Development of a fracture register

• Treatment of patients over 75 in line with NICE technology appraisal

• Prescribing of vitamin D3/ calcium for patients in a nursing home or residential care

• Management of patients over 65 with long-term exposure to steroids (three months or more)

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