Scottish Govt must now deliver a mandate for universal Fracture Liaison Services and set rigorous care quality standards – just like England and Wales
A failure to deliver high-quality Fracture Liaison Services (FLS) across Scotland is contributing to a devastating increase in broken hips, say campaigners.
FLS are early diagnosis services for osteoporosis, which is one of the top drivers of disability and early death amongst older people in Scotland.
Osteoporosis causes bones to weaken and break more easily – often just from a fall from standing height, a cough or a sneeze.
Half of women aged over 50 will suffer devastating broken bones as a result of osteoporosis, as well as a fifth of men. The end result of late treatment of osteoporosis is a life-threatening hip fracture, which kills over a quarter of sufferers within a year.
The number of people aged 50 and over who suffered hip fractures rose considerably in 2024 to 8,426* cases, a new report by Public Health Scotland shows.
The Royal Osteoporosis Society is now calling on the Scottish Government to deliver a mandate requiring all health boards to have high-quality Fracture Liaison Services (FLS). The Scottish Government must also set rigorous performance standards for FLSs to ensure enough patients are being identified, treated and monitored.
A mandate like this is already in place in England and Wales, leaving Scotland trailing behind, despite Glasgow being the birthplace of the FLS model, which has been copied in 57 countries.
Without a mandate from the Scottish Government, NHS chiefs are not incentivised to provide high-quality FLS in all areas. The lack of publicly available data – because a national audit of all FLSs has been delayed – is concealing life-threatening gaps where services are not present or performing.
Fracture Liaison Services are specialist NHS clinics that diagnose and treat osteoporosis in people over 50 after the first broken bone. Early detection and treatment – with inexpensive medication that is available on the NHS – is vital in preventing further fractures such as broken hips.
Currently, many patients in Scotland are not having their osteoporosis diagnosed and treated, which is leading to a devastating cascade of further avoidable fractures.
If Scotland had quality universal FLS coverage, over a five-year period, it is estimated:
- 8,899 fractures will be prevented – with 3,341 of those being hip fractures
- 60,000 acute bed days will be saved
- £104m in all associated costs can be saved – including £64m in acute care costs
Craig Jones, Chief Executive of the Royal Osteoporosis Society, said: “In England and Wales, the governments have promised a national roll-out of life-saving bone clinics, but the Scottish Government has, so far, declined to match that commitment, saying an audit of current services is needed first.
“The slow pace of auditing services is fuelling the rise in life-threatening hip fractures, which will lead to lost lives. Scotland invented the world standard for fracture care, so it’s hugely disappointing to see the nation fall behind England and Wales.”
Carol Mochan, Shadow Minister for Women’s Health, said: “Every one of these hip fractures represents a person whose life has been turned upside down, and too many could have been prevented.
“The Government knows what we need – a mandate for universal, high-quality Fracture Liaison Services. Wales has done it. England is doing it. There’s no reason people in Scotland should be left behind.”
Dr Sandesh Gulhane, Shadow Cabinet Secretary for Health and Social Care, said: “Scotland led the world in creating Fracture Liaison Services, but that early lead has been squandered.
“Latest figures show that the number of people aged 50 and over with hip fractures has been rising, with the largest increases amongst people aged 70 to 89. This could be prevented by timely diagnosis and treatment, yet only 41.5% of patients in Scotland receive a full inpatient care package within 24 hours of admission.
“The rise in hip fractures is the inevitable result of this inaction. The promised audit remains unfinished, and without a mandate for quality services, patients will keep falling through the cracks. The Scottish Government must act now to put Scotland back at the forefront of osteoporosis care.”
- Almost 200,000 people in Scotland are living with undiagnosed spinal fractures due to under-prioritisation of osteoporosis care.
- Osteoporosis affects around 250,000 people in Scotland, and it’s estimated that 41,900 ‘fragility’ fractures occur here every year.
- Fractures are the fourth worst cause of premature death and disability in Scotland.
- Half of women over 50 and one fifth of men will break a bone due to osteoporosis, a condition where bones lose strength and break more easily – even from a cough, a sneeze or a hug.
- Fractures are preventable with safe, effective medications that are highly affordable for NHS Scotland.
- 3.5 million people in the UK are estimated to have osteoporosis.
- Osteoporosis causes 500,000 broken bones every year in the UK, costing over £4.5 billion.
The report by Public Health Scotland also shows standards of care in hospital for people following a hip fracture have plummeted. The average time patients spent in the emergency department after a hip fracture increased to 5 hours 36 minutes, compared with 5 hours 10 minutes in 2023.
Just 30% were admitted to a ward within the four-hour target in 2024, which compares with 37% in 2023. Scottish hip fracture audit – reporting on 2024 – Scottish Hip Fracture Audit – Publications – Public Health Scotland
The Welsh Government issued a mandate to deliver universal FLS, which has been achieved. Wales also published a Quality Statement for Osteoporosis and Bone Health, which committed to delivering quality standards of care for people with osteoporosis. Targets have been set to identify, treat and monitor more patients.
England has committed to rolling out universal FLS by 2030.
