Don't forget the bones
Secondary prevention after heart attack is important, but we are missing opportunities for secondary prevention in another very important area.
Every year half a million older adults present to the NHS with fractures of the wrist, hip or vertebrae. Patients with such fragility fractures are at high risk of further fractures. Evidence based secondary prevention interventions with medication and non-pharmacological measures (e.g. strength and balance training) could prevent 46,000 recurrent fractures in these patients including 20,000 hip fractures, within the subsequent 5 years.
Our recent audit, commissioned by the Healthcare Quality Improvement Partnership and managed by the Royal College of Physicians, of services to support this secondary prevention(1) illustrated many opportunities for quality improvement. The majority of acute hospitals in England and Wales do not have such services and many services that exist are inadequately resourced to provide for their local population needs. As a result 70% of patients with fragility fractures will receive inadequate clinical care and unfortunately many of these will go on to suffer a further fracture that could have been prevented. This causes unnecessary pain and disability for individuals, exposes those who suffer hip fracture to a high mortality risk and puts additional strain on already over stretched NHS services.
With a growing elderly population adequate provision of secondary prevention services is much better for patients and much more cost effective, both core for the future for the NHS.
1. The Royal College of Physicians. Fracture Liaison Service (FLS) Database facilities audit. FLS breakpoint: opportunities for improving patient care following a fragility fracture. London: Royal College of Physicians, 2016.
Competing interests: MK Javaid has in last five years received honoraria, travel and/or subsistence expenses from: Amgen, Eli Lilly, Medtronic, Norvartis, Proctor and Gamble, Servier, Shire, Internis, Consilient Health, Stirling Anglia Pharmaceuticals, Mereo Biopharma, Optasia