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Osteoporosis: Early Detection

Volume 826: debated on Thursday 19 January 2023


Asked by

To ask His Majesty’s Government what steps they are taking to improve rates of early detection of osteoporosis.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and declare my interest as co-chairman of the APPG on Osteoporosis and Bone Health.

The Government are committed to improving outcomes for those living with osteoporosis. NHS England, through its Getting It Right First Time programme, is exploring how best to support integrated care systems in the detection and management of osteoporosis. This includes a focus on improving provision of and equity of access to high-quality secondary fracture prevention services, such as fracture liaison services that help to identify those most at risk and offer preventive support.

My Lords, osteoporosis affects half of women and a fifth of men over the age of 50, but all too frequently its late diagnosis means broken bones, pain, reduced independence and, sometimes, life-changing disability. Yet there is no excuse for that, because we have it in our power to identify those most at risk. Is my noble friend aware that almost two-thirds of people with one of three major risk factors have never received a bone health assessment, while a simple and cheap assessment tool proven to prevent hip fractures can be used in five minutes in a GP’s surgery? As the costs of helping people recover from fractures are far higher than the costs of identifying and treating those at risk, should the National Screening Committee not urgently reconsider the case for a targeted national screening programme, so that as a country we invest just millions of pounds in preventing harm rather than billions in managing failure?

I agree with my noble friend that prevention is always better than cure. The beauty of these processes is that I get to swot up, and I learned that the second largest bed-intake cause is actually a fractured femur from osteoporosis, so he is correct. We have a target that 95% of patients will get a check within six weeks by March 2025. It is good that musculoskeletal services are now part of the national improvement programme, but we clearly need to make sure we are on top of that.

My Lords, a year ago the Minister’s predecessor said to the House that he hoped NHS England would ensure that effective fracture services were universal. However, unlike in Scotland and Wales, that is not the case in England. Is not part of the problem with healthcare in this country that the Government struggle to resource treatment and pay for those who provide it while failing to invest in prevention and public health initiatives? What action are they taking to ensure that osteoporosis is given sufficient priority by recognising that it needs to be considered in parity with other long-term conditions?

The noble Lord refers to the fracture liaison services. It is the responsibility of all ICBs to roll out those services or their equivalent. Regarding the numbers that he cited, I should say that 51% of ICBs have a fracture liaison service in that shape or form and the others have different versions of it, and they are all responsible for rolling those out. At the same time, they are also responsible for musculoskeletal services, to make sure that we have nationwide provision for it.

My Lords, the Minister said that prevention is better than cure. That is obviously the case, yet we have severely failed to prevent the horrible development of this crippling disease, which mainly affects women, as has been said. He has talked about a 95% target. What is he going to do, as the Minister with some responsibility in this area, to ensure that the target is met, given the failures in the past? Will he find a way of reporting back to the House on progress in reaching that target?

One of the many things for which I am responsible is NHS performance, as I think the House is aware, and these are exactly the sorts of issues that I am interested in, so I am happy to undertake to give an update on that. We all know that effective spend, which we need to make sure is always put to best use, involves identifying where these problems are, and 3 million people are affected every year. As I said earlier, a fractured femur is the second biggest reason for intake into hospitals, in terms of beds. That is something that I am happy to be measured by and report back on.

My Lords, following on from the question from the noble Lord, Lord Rennard, is it not the case that, while the Government accept that everyone over 50 should have equal access to fracture liaison services, insufficient progress is being made towards that crucial goal? Is there not a case for the appointment of a strong and determined national specialist adviser on osteoporosis to speed things up?

As I mentioned earlier, this is the responsibility of all the ICBs. Part of my job is making sure that we as Ministers now regularly communicate with all the ICBs. There are a number of boards that I regularly speak to, check in with and visit on a frequent basis, and one of our checkpoints is making sure that they are on top of services such as these. I am delighted to say that every ICB has now set up a community base fall service, to make sure that if someone should fall in a case such as these, rather than an ambulance and two paramedics, we can have someone specially set up to right these people, put them on their feet and avoid an A&E visit.

My Lords, the UK primary care base trial on screening for osteoporosis in older people examined a systematic approach to identifying older women for fracture prevention, leading to a 28% reduction in hip fracture risk, significantly reducing costs and seeing increased adherence to treatment. What plans are there to extend and learn from this important study?

I thank the noble Baroness for bringing this to my attention. Clearly a 28% reduction is impressive and something that we should take seriously. If she can give me the reference, I will definitely take it up and write back.

My Lords, is not exercise when growing as an adolescent, particularly impact exercise, important for stimulating bone growth? Should more not be done to encourage impact exercise among children and teenagers, particularly among girls, who do not always want this—in other words, running, jumping on the spot and so on?

As a player of rugby, which probably has far too many impacts, I agree with the sentiment that exercise is always a good thing, whatever stage of life one is at. Also, we all know that vitamin D is a vital part of helping against bone weaknesses. Things as simple as spending more time in the sun in summer or taking vitamin D supplements in the winter are vital prevention methods. I agree about exercise, but all these measures should be rewarded and promoted.

I am sorry to correct the Minister but vitamin D does not affect osteoporosis. It is helpful for osteomalacia, the softening of the bones due to vitamin D deficiency, but not very useful for osteoporosis. Exercise is valuable, and at any age it is the only thing that prevents osteoporosis. There are treatments available for osteoporosis but they are not very nice—they involve injections—and are quite expensive. Exercise is the thing.

I thank the noble Lord. As I say, part of the beauty of this job is being educated. I will take that back to my officials and query them on my briefing.

My Lords, could the Minister comment on whether the department of health is working with the department of energy to ensure that we can afford to heat our swimming pools? Swimming is a really good exercise and reduces the risk of falls, particularly in older people.

As previously mentioned, prevention is always better. Exercise, as I have learned from my noble friend Lord Sandhurst, is a good way of preventing osteoporosis. Where we can find cost-effective ways of getting that exercise, such as swimming pools, we should be promoting them.

My Lords, having identified the causes of osteoporosis, could my noble friend say how the message is being communicated? He mentioned vitamin D, which could be an issue, but the reality is that some vulnerable women in communities do not get some of the messages regarding exercise or indeed have access to those facilities. I know walking and so forth can help, but what are the Government doing to put that preventive message across in a very firm and consistent way?

My noble friend is correct that education and awareness are always the start point on any of these health issues. It was a key part of the women’s health strategy that came out in 2022. Osteoporosis is a key part of that, and promotion and awareness are a key part if it as well.