Healing the fracture in the system: the case for universal fraction liaison services access
pharmafile | November 28, 2025 | Feature | Medical Communications, Research and Development | Osteoporosis
By Tina Backhouse
In 2024, the UK government committed to achieving 100% coverage of Fracture Liaison Services (FLS)across the NHS in England.1
This is more than just a policy pledge; it’s a potentially transformative milestone in how we address osteoporosis and its devastating consequences. But turning that ambition into reality will require coordinated action, sustained investment and recognition that osteoporosis is, first and foremost, a women’s health issue.
Osteoporosis: the underestimated health threat facing women
Osteoporosis affects more than 3.5 million people in the UK,2 but the burden falls unevenly. Women, in particular postmenopausal women, bear the overwhelming burden.3,4 One in two women over the age of 50 will suffer an osteoporotic fracture in their lifetime, compared with one in five men.5
These fractures can be life-altering or even life-limiting. A hip fracture, for instance, can lead to a 20% increase in mortality within the first year.6 Yet osteoporosis is often called a ‘silent disease’, invisible until the first fracture occurs.7
Making prevention mainstream and the cost of inaction
For too long, osteoporosis has been treated as a niche or inevitable part of ageing, rather than as a preventable and treatable condition.8 We would never accept such a passive approach to heart disease or diabetes – and we should not accept it for osteoporosis.
Treating this condition early is imperative for so many, and failing to address the osteoporosis care gap is not only a personal tragedy for patients – it’s a significant strain on the NHS and the wider economy.9 Each year, fragility fractures cost the NHS and social care services an estimated £4.4bn. This figure is set to rise sharply as the UK’s population ages. Hip fractures alone account for more than 1.8 million bed days annually, contributing to hospital overcrowding and delays in other treatments.10
Preventing even a fraction of these fractures through early detection and intervention could release much-needed capacity in an already overstretched health service.11 FLS are underpinned by evidence demonstrating that they are clinically effective as well as cost effective,12 but they can only work if they are available to everyone who needs them, everywhere in the country.
Why fracture liaison services matter
FLS act as a crucial safety net. They ensure that any patient over 50 who presents with a fragility fracture is systematically assessed, diagnosed and treated for underlying osteoporosis to prevent further breaks.13 Every pound spent on FLS can generate multiple pounds in savings14 through reduced hospital admissions, lower demand for residential care and improved patient independence.
However, access remains patchy. At present, only around half of NHS Trusts in England have a fully operational, high-quality FLS.15 We can see from this postcode lottery that thousands of patients are not receiving timely treatment and intervention.11
From promise to practice
The government’s pledge to deliver universal FLS coverage by 2030 is welcome. To deliver this, the NHS will need:
- A mandate from the government that everyone over 50 should be covered by a quality FLS
- £30m per year additional investment in FLS to fill the gaps in population coverage and quality
- A national clinical director to lead the change.16
Osteoporosis should be addressed as part of the broader women’s health agenda. As well as the above, I believe that incorporating bone health checks into midlife health assessments, menopause care and primary prevention programmes could dramatically improve early detection.
The way forward
In my opinion, universal access to high-quality FLS could be one of the most impactful public health reforms of the decade. But achieving it will require the same urgency, coordination and political will that we have seen in other major NHS priorities.
For millions of women across the UK, this is about more than preventing fractures. It’s about protecting their independence, dignity and quality of life.
Tina Backhouse is Vice President Europe for Government and Policy at Theramex
Tina has over 25 years’ experience in global senior leadership roles in the pharmaceutical industry. She brings experience of launching innovative products across a diverse range of therapy areas within both large and small pharma companies.
Most recently Tina joined Theramex to lead the UK Women’s Health business in July 2020 as General Manager, and has since been appointed as Vice President Europe for Government and Policy for Theramex in 2025. She is also a member of the DWP Menopause Advisory Group.
References
1 UK Parliament. (2024) House of Lords Library. Fracture liaison services: Towards 100% coverage in England. Available at: Fracture liaison services: Towards 100% coverage in England – House of Lords Library [Last accessed November 2025]
2 Royal Osteoporosis Society. Making osteoporosis a priority for politicians. Available at: https://theros.org.uk/how-you-can-help/get-involved/campaign-with-us/making-osteoporosis-a-priority-for-politicians/#:~:text=Share-,Making%20osteoporosis%20a%20priority%20for%20politicians,receiving%20the%20treatment%20they%20need. [Last accessed November 2025].
3 Royal Osteoporosis Society. Media Toolkit – Key Facts and Statistics. Available at: https://theros.org.uk/about-us/media-centre/media-toolkit/ [Last accessed November 2025]
4 British Menopause Society. (2023) Prevention and treatment of osteoporosis in post menopausal women. Available at: 06-BMS-ConsensusStatement-Prevention-and-treatment-of-osteoporosis-in-women-SEPT2023-A.pdf [Last accessed November 2025]
5 T.P van Staa, E.M Dennison, H.G.M Leufkens, C Cooper, Epidemiology of fractures in England and Wales,
Bone, Volume 29, Issue 6, 2001,https://doi.org/10.1016/S8756-3282(01)00614-7.
6 Downey C, Kelly M, Quinlan JF. Changing trends in the mortality rate at 1-year post hip fracture – a systematic review. World J Orthop. 2019 Mar 18;10(3):166-175. doi: 10.5312/wjo.v10.i3.166. PMID: 30918799; PMCID: PMC6428998.
7 NIAMS. Osteoporosis. Available at: https://www.niams.nih.gov/health-topics/osteoporosis [Last accessed November 2025]
8 Sale, J.E., Frankel, L., Bogoch, E. et al. The experience of feeling old after a fragility fracture. BMC Geriatr 24, 180 (2024). https://doi.org/10.1186/s12877-024-04769-w
9 IOF. International Osteoporosis Foundation. Burden of Osteoporosis. Available at: https://www.osteoporosis.foundation/policy-makers/burden-osteoporosis. [Last accessed November 2025]
10 GOV.UK. (2022) Falls: applying All Our Health. Available at: https://www.gov.uk/government/publications/falls-applying-all-our-health/falls-applying-all-our-health [Last accessed November 2025]
11 Parliament UK. Written Evidence submitted Royal Osteoporosis Society. Available at: https://committees.parliament.uk/writtenevidence/112974/pdf [Last accessed November 2025]
12 ROS. (2019) Effective Secondary Prevention of Fragility Fractures: Clinical Standards for Fracture Liaison Services. Available at: https://theros.org.uk/media/1eubz33w/ros-clinical-standards-for-fracture-liaison-services-august-2019.pdf [Last accessed November 2025]
13 ROS. Fracture Liaison Services. Available at: https://theros.org.uk/healthcare-professionals/clinical-quality-hub/fracture-liaison-services/ [Last accessed November 2025]
14 Leal J, Gray AM, Prieto-Alhambra D, Arden NK, Cooper C, Javaid MK, Judge A; REFReSH study group. Impact of hip fracture on hospital care costs: a population-based study. Osteoporos Int. 2016 Feb;27(2):549-58. doi: 10.1007/s00198-015-3277-9. Epub 2015 Aug 19. PMID: 26286626; PMCID: PMC4740562.
15 APPG. ROS. APPG on osteoporosis and bone health. Available at: https://strwebprdmedia.blob.core.windows.net/media/31tbj2dt/appg-on-osteoporosis-and-bone-health-fls-inquiry-inquiry-report-2021.pdf [Last accessed November 2025]
16 IOF. International Osteoporosis Foundation. Better Bones Campaign – calling for 100% FLS coverage in England and Wales. Available at : https://www.osteoporosis.foundation/news/better-bones-campaign-calling-100-fls-coverage-england-and-wales-20240121-1645?utm_ [Last accessed November 2025]
