Across the NHS, clinicians have been calling for progress on osteoporosis for years. Yet nearly two years on from a clear national commitment, there is still no plan for delivery – and no progress.
This is not about new treatments or complex innovations. It is about a basic standard of care, routine in more than 60 countries, but still missing in half of NHS trusts in England: fracture liaison services (FLS). These services identify patients after a fracture and ensure they are assessed and treated to prevent the next – often more serious – fracture.
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Today, two-thirds of the 3.5 million people living with osteoporosis are not receiving medication, not because treatments don’t exist, but because the system fails to deliver them. Too often, patients are fixed up and forgotten – left exposed to further fractures that could have been prevented.
The consequences are grave. Fractures are a major driver of emergency admissions, and as the population ages, demand will only increase. A broken hip is frequently the start of a rapid decline, with more than a quarter of patients dying within a year. Yet effective treatments exist, often costing as little as £1 a week.
The challenge is not clinical – it’s one of delivery.
At the 2024 election, there was a rare political consensus on the solution. A national rollout of FLS to every area by 2030 was the policy for all parties. Health and social care secretary Wes Streeting said this would be a first act in post. Ministers have repeated the commitment 63 times in Parliament and the press.
But on any credible trajectory to 2030, services should now be expanding at pace. Two years on, we would expect 24 trusts missing FLS to have been covered. But none have, and 60 trusts still lack provision. No national delivery plan has been published, and there are no clear milestones or funding to support implementation.
In some areas, plans for new services have been paused in anticipation of a national rollout that has yet to materialise. The result is a system in paralysis when it should be moving at a pace.
Delay carries both human and financial costs. More than 2,000 people die each year following hip fractures that FLS could help prevent. Since the election, the NHS has spent an estimated £150m treating fractures FLS could have prevented – more than double the cost of rollout.
New Zealand now covers almost its entire population with FLS, while Japan has quadrupled its provision since 2022. Within the UK, Wales has achieved universality and set world-leading performance targets. England is falling behind.
Mr Streeting has rightly emphasised a shift from sickness to prevention. Osteoporosis is a clear test of whether that ambition translates into practice. If we cannot act here – where the pledge has been made 63 times, the solution is clear, and the treatment is low-cost – it is difficult to see where we will.
What is needed now is not further commitment, but a plan: one that sets out how rollout will begin, how it will be funded, and how progress will be tracked.
Without it, a widely supported prevention policy risks becoming one that the NHS cannot deliver, with grave consequences for trust and confidence.
