{
  "abstract": "The 2021 UK Chief Medical Officers' annual report highlighted poorer health in coastal communities but did not include osteoporosis or secondary fracture prevention. Using Fracture Liaison Services database (FLS-DB) data, FLSs in coastal areas were shown to have poorer performance and lower parenteral osteoporosis medication recommendation rates, supporting inclusion of FLSs in coastal health improvement plans. A number of studies have highlighted socio-economic deprivation as a predictor of fragility fractures and poorer outcomes after fracture. In parallel, coastal areas are recognised to be areas with poorer health outcomes, in part due to socio-economic deprivation.\n\nPurpose: To describe secondary fracture prevention in terms of FLS provision and quality in coastal vs. non-coastal healthcare settings using routinely collected audit data.\n\nMethods: A cross-sectional, ecological analysis using the missed opportunity counts from the national Fracture Liaison Service (FLS-DB) and Hip Fracture (NHFD) Databases of England and Wales audit data with Office for National Statistics classification of coastal towns.\n\nResults: Results Coastal sites were not significantly more likely to be non-FLS vs FLS providers (38% vs 24%, p = 0.18). However, coastal FLSs had higher missed opportunity patient counts than non-coastal FLSs (p = 0.02), with lower vertebral identification rates (14.2% vs 20.9%, p = 0.02). While treatment rates were similar, coastal FLSs had significantly lower rates of parenteral anti-resorptive therapy recommended (p < 0.001).\n\nConclusion: We have demonstrated a coastal deleterious effect on the quality of secondary fracture prevention of FLS providers as measured by missed opportunities for treatment, vertebral fracture identification and recommendation of parenteral anti-resorptive therapies. Coastal health priority plans in the NHS should prioritise effective FLS provision.",
  "abstract_shown": true,
  "affiliations": [
    "Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, UK",
    "NDORMS, University of Oxford, Oxford, UK",
    "Falls and Fragility Fracture Audit Programme, Royal College of Physicians, London, UK"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "L. Pugh"
    },
    {
      "affs": [
        1
      ],
      "name": "F. Clemeno"
    },
    {
      "affs": [
        2
      ],
      "name": "R. Ghumman"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "MK Javaid"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ap9v1xyvy6km2.bib",
  "cited_by": 0,
  "doi": "10.1007/s11657-026-01786-7",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13723606/",
  "id": "ap9v1xyvy6km2",
  "issns": [
    "1862-3522",
    "1862-3514"
  ],
  "landing_url": "https://doi.org/10.1007/s11657-026-01786-7",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "2732|Bone health and osteoporosis research"
    ]
  ],
  "openalex": "W7224993076",
  "pdf_url": "https://link.springer.com/content/pdf/10.1007/s11657-026-01786-7.pdf",
  "pmcid": "PMC13723606",
  "pmid": "42965724",
  "published": "2026-10-31",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/ap9v1xyvy6km2.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T12:22:12Z",
      "native_id": "PMC13723606",
      "source": "pmc",
      "url": "https://doi.org/10.1007/s11657-026-01786-7"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2732|Bone health and osteoporosis research",
      "subfield": "surgery"
    }
  ],
  "title": "Inequality in secondary fracture prevention supports prioritisation of fracture liaison services in coastal health plans in England and Wales",
  "title_text": "Inequality in secondary fracture prevention supports prioritisation of fracture liaison services in coastal health plans in England and Wales",
  "type": "peer-reviewed",
  "updated_at": "2026-11-05T12:20:23Z",
  "url": "https://research.draconitic.com/paper/ap9v1xyvy6km2",
  "venue": "Archives of Osteoporosis",
  "versions": []
}