Peer Review of Osteoporosis and Metabolic Bone Services

The National Osteoporosis Society is undertaking peer review of osteoporosis and metabolic bone services, which includes review of a Fracture Liaison Service where there is one.


The primary objective of peer review is to provide quality assessment and assurance to improve performance based around professional credibility. Peer review of clinical services has been in existence for over a decade and the process has consistently supported an academic and non-threatening means to advance and develop clinical practice and service provision for the good of patients. 


Peer review provides a means of assessing clinical care against agreed standards. It also addresses agendas of clinical governance, practitioner revalidation, and service development, with a view to facilitating all UK centres to develop a quality assured level of care for patients with osteoporosis and metabolic bone diseases. Additional benefits of the peer review scheme include lifting morale of health care providers by ensuring that clinical teams’ voices are heard to help shape the future delivery and development of their service. The primary aim of the peer review scheme, however, is to improve services for patients with osteoporosis and metabolic bone diseases.


Peer review is voluntary; the first step is to register your interest and to complete an application form which must be approved and supported by senior management of the Trust to be visited. The peer review visit will take place over 1 day, during which the review team will evaluate and appraise osteoporosis and metabolic bone care and service provision against basic standards; where a Fracture Liaison Service is present, this will be also be included. Visits will form the basis for an exchange of ideas and experiences and allow areas of concern to be explored. Areas of excellent practice will be highlighted and potential for further development will be recommended.

The peer review team is multi-disciplinary and will consist of a clinical representative from some of the following specialities: rheumatology, endocrinology, orthogeriatrics, osteoporosis/fracture liaison nursing, DXA radiography and other relevant health professionals, who will act in an advisory capacity. Any conflicts of interest will be declared. The team will visit the centre to be reviewed and interview clinical, managerial and clerical staff of the centre and relevant clinicians of allied specialities.

A final written report will be produced following the visit, which will highlight examples of best practice, matters for consideration and recommendations for further development. The report will be supportive, but will highlight any areas of concern. The report will be confidential, and the final version will be sent to the Lead Clinician of the centre and the National Osteoporosis Society. No other party without the express permission of the Lead Clinician will have access to the report, though anonymised data from peer-reviewed centres may be used or presented by the National Osteoporosis Society. Those reviewed will have the opportunity to provide feedback on the review process. The recommendations of the peer reviewers will not be legally or otherwise binding for the clinical team being peer reviewed or the Trust.

Register Your Interest

If you would like to register your interest to receive a review, or to find out more, please contact Hilary Arden on 01761 473112 or email

Objectives of Peer Review:

1. Standard-setting 

a. Current lack of UK standardisation of care
b. Determine best practice 
c. Provide formal accreditation to centres

2. Provides feedback to Trust/CCG from expert and objective external reviewers 

a. Variable reception and perception from CCGs and Trusts with respect to service delivery in osteoporosis/metabolic bone diseases
b. Peer review provides objective evidence of any shortfalls in care
c. Variability in provision of diagnostic services such as DXA can be addressed comparatively and objectively

3. Enhance the rationale for business case development

a. Bring together disparate specialities to unify thinking in osteoporosis and metabolic bone disease services locally and across the UK

4. Increase profile and credibility of osteoporosis and metabolic bone diseases in the UK

5. Provide accreditation of recognised ‘osteoporosis centres’

Potential Benefits:

To patients:

1. Equality of access to best care across the UK
2. Recognition by patients that being cared for in a ‘quality assured’ centre with appropriate accreditation

To clinicians:

1. Sharing of best practice
2. Empowerment of clinicians
3. Service development opportunities
4. Peer review reports provide evidence for purchasers
5. UK standards in DXA reporting
6. UK standards in fracture risk assessment
7. UK standardisation in clinical data gathering and potential for research
8. UK databases on responses to novel therapies
9. UK-wide audits