Inequality in secondary fracture prevention supports prioritisation of fracture liaison services in coastal health plans in England and Wales
- 1Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, UK
- 2NDORMS, University of Oxford, Oxford, UK
- 3Falls and Fragility Fracture Audit Programme, Royal College of Physicians, London, UK
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.
Purpose: To describe secondary fracture prevention in terms of FLS provision and quality in coastal vs. non-coastal healthcare settings using routinely collected audit data.
Methods: 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.
Results: 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).
Conclusion: 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.
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BibTeX
@article{pugh2026inequality,
title = {{Inequality in secondary fracture prevention supports prioritisation of fracture liaison services in coastal health plans in England and Wales}},
author = {L. Pugh and F. Clemeno and R. Ghumman and MK Javaid},
journal = {Archives of Osteoporosis},
year = {2026},
month = oct,
doi = {10.1007/s11657-026-01786-7},
url = {https://doi.org/10.1007/s11657-026-01786-7},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Inequality in secondary fracture prevention supports prioritisation of fracture liaison services in coastal health plans in England and Wales
AU - L. Pugh
AU - F. Clemeno
AU - R. Ghumman
AU - MK Javaid
PY - 2026
DA - 2026/10/31
JO - Archives of Osteoporosis
DO - 10.1007/s11657-026-01786-7
UR - https://doi.org/10.1007/s11657-026-01786-7
AB - 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. Purpose: To describe secondary fracture prevention in terms of FLS provision and quality in coastal vs. non-coastal healthcare settings using routinely collected audit data. Methods: 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. Results: 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). Conclusion: 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.
SN - 1862-3522
SN - 1862-3514
ER -