Scanning services for osteoporosis patients ‘in crisis’

Scanning services that identify the bone-weakening disease osteoporosis are a “diagnostic specialty in crisis”, experts have claimed, with “systematic failings” putting people at risk of life-changing injuries.

Underinvestment prior to the pandemic and pressures added by the Covid-19 backlog have brought “services to their knees”, a report by the Royal Osteoporosis Society (ROS) said.

Osteoporosis is a condition that weakens the bones, making them more likely to break. It impacts an estimated 3.5 million people in the UK and leads to about 500,000 fractures a year.

It is diagnosed using scans that assess bone density, known as dual energy X-ray absorptiometry (DXA).

The ROS carried out a review of DXA scanning facilities on behalf of the All Party Parliamentary Group (APPG) on Osteoporosis and Bone Health, highlighting “a chronic state of crisis” which “dwarves the challenges facing CT, ultrasound and MRI scanning following Covid-19”.

Craig Jones, chief executive of the ROS, said “systemic failings are putting tens of thousands of patients at risk of life-changing injuries which cost people their careers and, sadly in the case of many hip fracture patients, their lives”.

He added: “This is the result of chronic under-prioritisation of bone health in the NHS, which is nonsensical since fractures are the second biggest filler of hospital beds.”

According to the NHS, the most common injuries in people with osteoporosis are broken wrists, broken hips or broken spinal bones.

Women are also more at risk of developing the condition as the menopause accelerates bone loss due to a decline in female sex hormone oestrogen.

DXA scans are usually accompanied by a report and personalised advice for the patient, as well as a fracture risk assessment which outlines their risk of breaking a bone.

A Freedom of Information (FoI) request made by the ROS to NHS trusts and health boards across the UK – to which 137 responded – found 47% did not include personalised advice for patients in their reports.

The same proportion did not include statements defining fracture risk.

The society also raised concerns about potential negligence on radiation safety.

Some 22% of respondents to the FoI did not assess their radiation safety through the routine audits, the ROS said, meaning 115,528 people have had scans at centres that cannot assure radiation safety.

The ROS claims backlogs of people waiting for a DXA scan are “wildly disproportionate” to other services such as MRIs, CT scans and ultrasounds.

Their analysis found people waiting longer than the six-week target for a scan jumped from 2,245 to 20,000 between 2020 and 2022.

Almost half of services (46%) are missing the target, the ROS said, with 26% of services taking longer than 13 weeks.

One patient said waiting for a scan was “hard”. They added: “I kept waking up at night thinking ‘I’m going to die now with my broken bones. If I’ve had a rib fracture, it’s highly likely that I will have a hip fracture’.

“My second DXA scan took six months. We need to do something about it. People shouldn’t have to suffer like I did.”

The ROS said the Government’s community diagnostic centre (CDC) programme, which aims to speed up access to tests and checks, is a “particularly appropriate opportunity” to bolster the DXA service, but to date it has “not been front and centre of this strategy, where it belongs”.

In November, the Government said all of its planned 160 CDCs would be open by March 2024, a year ahead of the original target.

Its Major Conditions Strategy will also cover musculoskeletal conditions, including osteoporosis.

However, Mr Jones warned: “The Government’s forthcoming Major Conditions Strategy won’t be fit-for-purpose unless it includes an actionable plan on bone health, including ensuring that DXA services are embedded in the new Community Diagnostic Centres as an early win.”

NHS England and The Department of Health and Social Care have been approached for comment.