What should our priorities be in Primary Care?
Identification, follow-up and long-term management
In November 2017 the NOS published Quality Standards for Osteoporosis and Prevention of Fragility Fractures to reflect and encourage good practice for all services, including primary care, involved in the fragility fracture prevention pathway.
Primary Care plays a key role in:
- Identifying people at risk of fragility fracture and carrying out the appropriate assessments;
- Providing follow-up support to patients;
- Supporting the long-term management of osteoporosis with the patient and their carers.
Brief information on the elements of the standards particularly relevant to Primary Care is given below. For full details, please refer to the standards.
Standard 1: Identifying people at risk of fragility fractures
- Adults aged ≥50 years with a new fragility fracture are systematically and proactively identified
- Adults aged ≥50 years with a vertebral fracture are systematically and proactively identified
- Adults with co-morbidities or taking drug therapies commonly associated with increased fracture risk are identified
- Adults aged ≥65 years with a history of two or more falls in the past year are identified
Standard 2: Assessing fracture risk
- Investigations to assess risks of fragility fractures and falls are offered to adults identified by the fracture prevention pathway – for example, fracture risk assessment using FRAX or QFracture, Quality-assured axial DXA within 12 weeks from referral, relevant laboratory and imaging investigations to clarify diagnosis and inform treatment decisions
Standard 3: Information and support
- Adults are offered relevant information and engaged in discussion and decisions made to agree their care plan
Standard 4: Interventions to reduce fracture risk
- Adults at high risk of fragility fracture are offered appropriate drug treatment within 5 weeks of assessment and are given information about how to take the drug treatment
- Adults at high risk of falling are referred to falls prevention services
Standard 5: Follow-up and long-term management
- Adults who are recommended a drug treatment for osteoporosis are asked about adverse effects and adherence to treatment, and a long-term treatment review is carried out
Standard 6: Reducing pain and functional impairment after fracture
- Adults who have a fragility fracture are offered interventions to reduce pain and functional impairment
Download the full standards: Quality Standards for Osteoporosis and Prevention of Fragility Fractures
The Department of Health in England has produced commissioning guidance for the NHS in the Falls and fractures section of the Prevention Package for Older People. The key objectives illustrated in the pyramid below provide GPs and service commissioners with a stepwise implementation plan, based on the size of the impact, from a clinical and cost-effectiveness standpoint.
In 2017, NICE published Quality Standard [QS149] Osteoporosis. The standard contains four quality statements: Assessment of fragility fracture risk; starting drug treatment; adverse effects and adherence to treatment; long-term follow up.
In Scotland, health professionals should follow the Scottish Intercollegiate Guidelines Network (SIGN) guidance: Management of Osteoporosis and the Prevention of Fragility Fractures (142) and Management of Hip Fracture in Older People (111).
More information on priorities for Primary Care, including an overview of the Quality and Outcomes Framework, is provided in the 'Frameworks and Guidance' section of this resource.