This is a category taken from the full feed of Musculoskeletal and Arthritis news provided by ARMA's members.

Tag: osteoporosis

by Ellie Davies, Acting Project Manager, Falls and Fragility Fracture Audit Programme (FFFAP)

The challenge:

520,000 cases of fragility fracture occur every year amongst those (primarily over-50s) suffering with the bone-weakening disease known as osteoporosis. That is 520,000 broken bones caused by as little as slipping in the shower, stepping off a curb even. This is not only a huge economic burden on the NHS, approximately £5.25 billion, but an epidemic that has lasting physical and emotional repercussions for sufferers. It is upsetting to learn that 42% of older people say that osteoporosis has made them feel more socially isolated.

And it’s going to get worse. For as life expectancy steadily increases, it is estimated that there will be 25% more fragility fractures by 2030, and with that a 30% rise in healthcare costs that the NHS is simply not equipped to meet. A sobering prospect yes, but a crucial reminder nonetheless that now is the time to target improvement.

The solution:

Of course, eradicating the occurrence of fragility fractures altogether is the ultimate goal. However, given that any such fracture approximately doubles the risk of another, most likely within two years, focusing on secondary prevention is an effective starting point. Rapid assessment and timely treatment post index (first) fracture could avoid thousands of secondary cases.

Fracture Liaison Services (FLS): what are they and why are they so important?

A fracture liaison service (FLS) is an NHS service which aims to reduce the risk of subsequent fractures by systematically identifying, treating and referring all eligible patients aged 50 and over who have suffered a fragility fracture to appropriate services. A FLS is a proven approach, recommended by the Department of Health, for targeting these high-risk groups and improving secondary fracture prevention.

Fracture Liaison Service Database (FLS-DB): Our mission

According to the Fracture Liaison Service Database: Commissioner’s report 2019, there are significantly fewer fracture liaison services (FLSs) available for older patients in some parts of England and Wales than others. The Fracture Liaison Service Database (FLS-DB) is not only working towards improving the care provided by existing services but making these preventative services available more widely and avoid approximately 50,000 life-altering fractures in the process.

Dr Kassim Javaid, RCP clinical lead for the FLS-DB said “Those suffering broken bones are often the most vulnerable in society and it is unacceptable that such variation exists in service accessibility depending on where in the country they live. Fracture liaison services are proven to reduce the risk of experiencing further fractures, reducing the impact on older patients, and save the NHS millions of pounds. I implore all Clinical Commissioning Groups to ensure that FLSs are commissioned in their areas so that millions of older people receive the care they deserve.

What can you do?

  • Watch and share our short animation with information about fragility fractures and the care that should be provided
  • Read and share our guide to strong bones after 50 to help reduce the occurrence of fragility fractures
  • Find out about the data available for healthcare professionals and academic institutions for research and analysis
  • Follow us on twitter @RCP_FFFAP to find out more about the FLS-DB and other related audits.


New online infographic posters summarising the National Institute of Health and Care Excellence (NICE) guidance relevant to allied health professionals are now available online. Produced by the Institute of Osteopathy and endorsed by NICE, these easy to use resources provide a quick reference guide to current NICE guidance which can be printed and displayed in a clinical setting and support CPD.

There are currently three topics available; osteoarthritis, osteoporosis and spondyloarthritis, with plans to develop others in the near future.

The posters translate the NICE guidance into an easy to follow visual format to aid health professionals in primary care to identify and assess for the conditions and provide recommended pathways for care and management.

Matthew Rogers, Professional Development Manager at the Institute of Osteopathy and fellow of NICE, has been leading the project: “As a clinician I am acutely aware of the demands on health professionals to keep up to date with current guidance. As part of my fellowship with NICE I was keen to develop resources that would assist clinicians more easily embed the guidance into practice.”

The infographics are available to download for free from

On 30th November 2017, the National Osteoporosis Society published new Osteoporosis Standards and Vertebral Fractures Guidance for Health Professionals. The guidelines help health professionals provide the possible care for people with osteoporosis.

Fizz Thompson, Clinical Director for the National Osteoporosis Society, said: “The National Osteoporosis Society plays a key role in driving positive change in healthcare provision for people affected by fractures and osteoporosis, and these new documents – developed with clinical experts over a two year period – demonstrate how the Charity is setting the agenda in this area.

“The new guidance will raise awareness of the clinical significance of fractures among all clinicians and managers, and highlights the importance of undertaking further investigation and starting treatment in a timely way.”

View the documents here on the NOS website.

Read the Summer-Autumn 2017 update newsletter from the Department of Rheumatology at Portsmouth Hospitals NHS Trust, and the Portsmouth ARMA Network, which features:

  • Events and conference details
  • Flu and Pneumonia vaccination dates
  • “No Time for Pain” Patient-Carer workshop
    – discussing strategies for managing chronic and persistent pain associated to your Arthritis and Connective Tissue Disease with Partners/Family/Carers encouraged to attend as guests
  • “Tired of Being Tired” course
    – a 7 week programme exploring different self-management and relaxation techniques to improve quality of life


Alongside the update are the fliers and forms related to upcoming events –

Day to Day Living with Arthritis and Connective Tissues Diseases Conference 2017:

Programme for healthcare professionals with registration form.
Programme for Public and Patients with registration form.

Flier for Mini Love your Bones event in the Locks Heath, Parkgate, Titchfield and surrounding area.

“No Time for Pain” information leaflet.

On 10th July 2017, NICE issued a new Technology Appraisal (TA) for bisphosphonates which links the recommendations for drug treatments to advice on fracture risk assessment outlined in their earlier guidance. The TA is not intended to provide treatment thresholds but offers recommendations on cost-effective use of bisphosphonates when using fracture risk assessment as described in their guideline

For the first time, these recommendations will apply to men as well as women.

The TA says that provided an individual meets the criteria for fracture risk assessment there should be no financial barrier to them receiving bisphosphonates if they have a fracture risk of at least 1% using FRAX or QFracture. If that person does not get on with an oral treatment, intravenous (IV) bisphosphonates can be given instead.

Anne Thurston, Head of Policy at National Osteoporosis Society, says, “We welcome this clear guidance from NICE which says that cost will not be a barrier to these treatments for people at risk of a fracture from osteoporosis. Doctors need to look at a number of risk factors when they decide whether somebody would benefit from taking a medicine, and discuss the risks and benefits for that person.

“Now that NICE has issued this appraisal, we need to make sure that doctors are given the information they need to support their decisions about which patients need a treatment. Osteoporosis and fractures cause pain, disability and loss of independence and as a charity we are dedicated to ensuring that people have the care and support they need to live well with the condition. This MTA is a useful step in the right direction in the fight against broken bones.”

If a doctor wants to prescribe IV bisphosphonates without first trying an oral treatment, their fracture risk needs to be at least 10% using FRAX or QFracture.

Non-bisphosphonate treatments for osteoporosis will be reviewed by NICE in a separate piece of work which has not yet begun.

The NHS is legally obliged to fund treatments recommended by NICE’s technology appraisals – patients now have the right to these treatments, if their doctor believes they are clinically appropriate.

Health professionals will be required to make treatment decisions in a landscape with contradicting clinical guidance. For those who use the online tool FRAX to assess risk, NICE have signposted NOGG for more information about appropriate treatment thresholds.  The SIGN guideline on osteoporosis applies in Scotland and also offers sensible, evidence-based recommendations.

The full technology appraisal is available online at: Multiple Technology Appraisal (MTA) on the use of bisphosphonates.


NOS Events in late 2017

National Osteoporosis Society is holding a number of events for health professionals in the coming months.

  • 5th October 2017: Northern Ireland Osteoporosis Conference 2017
  • 12th October 2017: Wales Osteoporosis Advisory Group – Skills and Knowledge Workshop
  • 30th November: Osteoporosis Clinical Update (Birmingham)

To view more details and register for these events, some of which are free, please visit

TREATMENT OF OSTEOPOROSIS – ‘When to start, when to stop and when to change?’
30th November 2017, NEC Birmingham

With a brand new and innovative format this event promises to provide multidisciplinary clinicians in England with the opportunity to discuss the treatment and management of osteoporosis. The Clinical Update will bring a series of interactive clinical case discussions to you, presented as part of an expert discussion panel. You can expect to hear and participate in lively debate around identifying the high-risk patient, treatment options for the atypical patient and considerations for duration of treatment.

Early bird price is valid until 31st July.

For more information or to register for the event please click here.
Should you have any questions regarding the event please contact

The National Osteoporosis Society launched ‘A Message to My Younger Self’ – an awareness campaign about keeping bones strong and healthy – on 12th April which runs through World Osteoporosis Day on 20 October.

A survey conducted by the National Osteoporosis Society found four in 10 young adults have tried the fashionable ‘clean eating’ diets that often involve avoiding dairy, gluten, grain and sugar, while more than fifth had severely restricted their intake of milk and cheese. Fuelled by social media, the clean eating trend has surged in popularity in recent years, with some advocates achieving celebrity status with hundreds of thousands of followers.

However the charity warned that restrictive diets among younger generations might lead to widespread health issues in later life, including osteoporosis which causes bones to become fragile and break.

The diets often focus on avoiding processed foods and eating raw, unrefined produce. An essential nutrient for bone health is calcium, found in dairy products, green leafy vegetables and in some seeds and nuts. It’s essential to have plenty of calcium in your diet and the charity is worried that some people might not be getting enough.

The campaign generated extensive press coverage and on social media, highlighting crucial messages to millions of people across the UK about the importance of healthy eating for strong bones. It is also designed to get the conversation started about bone health with a younger audience, and the charity is asking grandmothers and mothers, grandfathers and fathers to send a message to their younger selves (the next generation) about how to keep bones strong and healthy.

Read more:

Fracture Liaison Services hold key to addressing crisis in osteoporosis, attendees at National Osteoporosis conference hear
The growing crisis in osteoporosis causing 300,000 debilitating fractures and costing the NHS £1.9bn every year can be effectively addressed by implementing and improving Fracture Liaison Services throughout hospitals and clinics across the UK, attendees at the National Osteoporosis Society conference in Birmingham heard in November.
Dr Kassim Javaid, Consultant in Metabolic Medicine at the Oxford University Hospitals NHS Trust – who spoke about Fracture Liaison Services at the conference – said: “The enormous personal cost of the often debilitating fractures caused by osteoporosis and the financial impact on our already under-pressure health service will only intensify as our population ages.
“Fracture Liaison Services are a proven way of addressing these issues and policy makers and health service managers would do well to heed the clear call at this conference to do more to help set them up.”
Over 700 health professionals working in the field of osteoporosis and bone health attended the conference. Speaking on the first day Sir Bruce Keogh, NHS England Medical Director, said osteoporosis was a “problem that will drain the national health service if we don’t do something about it.”