National policy
- National Service Framework for Older People:The English National Service Framework for Older People includes a Standard on falls, with one aim: to reduce injurious falls through the prevention and treatment of osteoporosis
- Department of Health (DH) Prevention Package for Older People:The Prevention Package section on falls and fractures has four key objectives illustrated by the DH Pyramid:
Click on image to enlarge
Two crucial epidemiological observations underpin the DH strategy:
- Half of hip fracture sufferers have broken another bone before breaking their hip
- Approximately one sixth of postmenopausal women have suffered a fragility fracture
Thus, half of all future cases of hip fracture will come from the sixth of the population that have already suffered a fragility fracture. Implementation of NICE Technology Appraisals on osteoporosis for today’s new fragility fracture sufferers and those that have fractured in the past could halve subsequent hip fracture rates. Fracture Liaison Services (FLS) are the evidence-based model shown to consistently deliver secondary preventive care. The DH economic evaluation of FLS for the population served by an average District General Hospital concluded:
“… over a 5 year period £290,708 is saved in NHS acute and community services and local authority social care costs, against an additional £234,181 revenue costs (falling both in year 1 and covering drug therapy for five years spent by the NHS on this patient cohort).”
NHS Evidence recommends Fracture Liaison Services as a model to improve quality and reduce costs in line with the Quality, Innovation, Productivity and Prevention initiative
- Best Practice Tariff for hip fracture (BPT): The BPT was launched in April 2010 to incentivise delivery of the hip fracture component of the DH Prevention Package. The BPT offers an incentive (of £445 per patient in 2010/11, rising to £890 per patient in 2011/12) when surgery is conducted within 36 hours of admission in combination with provision of effective ortho-geriatrician led medical care of the acute phase. BPT also requires hospitals to ensure that falls risk and bone health assessments are undertaken for all hip fracture patients, aiming to prevent secondary fractures.
- NICE Technology Appraisals and Clinical Guidelines: NICE has published four Technology Appraisals on osteoporosis treatments:
- NICE TA204: Denosumab ▼ for the prevention of osteoporotic fractures in postmenopausal women – October 2010
- NICE TA161: Alendronate (review), etidronate (review), risedronate (review), raloxifene (review), strontium ranelate and teriparatide (review) for the secondary prevention of osteoporotic fragility fractures in postmenopausal women (includes a review of NICE TA87) – October 2008
- NICE TA 160: Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women – October 2008
In 2004, NICE also published Clinical Guideline 21 on the assessment and prevention of falls in older people which is the subject of a review during 2011.
- Policy documents in the devolved countries of UK:These include:
- Up and About: Pathways for the Prevention and Management of Falls and Fragility Fractures (Scotland) – January 2010
- National Service Framework for Older People in Wales: Falls and Fractures Standard – March 2006
- The Prevention and Management of Fragility Fractures in Northern Ireland – June 2009
The Breaking Point Report provided a snapshot of the current situation for women with osteoporosis in the UK.
Breaking Point described the practical steps that must be taken by healthcare professionals, policy makers and commissioners, as well as the public to prevent avoidable suffering and cost of osteoporotic fractures.
… over a 5 year period £290,708 is saved in NHS acute and community services and local authority social care costs, against an additional £234,181 revenue costs (falling both in year 1 and covering drug therapy for five years spent by the NHS on this patient cohort).
