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Approximate read time: 10 minutes

On 16 October 2025, the House of Lords will consider the following question for short debate:

Lord Black of Brentwood (Conservative) to ask His Majesty’s Government what progress they have made towards establishing fracture liaison services across England, and what plans they have to meet their commitment to provide universal coverage by 2030.

Lord Black is co-chair of the All-Party Parliamentary Group (APPG) on Osteoporosis and Bone Health.[1] The Royal Osteoporosis Society (ROS) acts as the APPG’s secretariat.

1. Osteoporosis and fragility fractures

Osteoporosis is a condition characterised by low bone mass and structural deterioration of bone tissue.[2] This causes bones to be more fragile and susceptible to fracture.

Osteoporosis is asymptomatic until ‘fragility fractures’ occur. Fragility fractures are bone breaks that would be very unlikely in someone without a decline in bone density. The National Institute for Health and Care Excellence (NICE) has estimated that in England and Wales, around 180,000 fractures each year are the result of osteoporosis.[3] NICE notes this figure does not include all vertebral fractures: fractures in the spine, usually sustained from lifting or bending. Vertebral fractures present as back pain, which is often misdiagnosed as a muscular issue.

The Royal Osteoporosis Society (ROS) has explained that fractures are painful and can be challenging to recover from.[4] Fractures can lead to social isolation, loss of mobility and independence, and depression.

Osteoporosis is more common in older people. Bone density declines after around 35 years of age, with a steep decrease in the oldest age groups.[5] Other factors can accelerate the decline in bone density, including smoking, diet and some illnesses. The risk of fragility fractures is increased for people who are at greater risk of falling. This can include people with visual impairments, muscular weakness, cognitive impairment and issues with coordination and balance.

Women are at greater risk than men.[6] For women, oestrogen levels are key for bone health, and a decline in oestrogen, for example after menopause, increases the risk of developing osteoporosis. NICE has estimated that more than 2 million women in England and Wales have osteoporosis. For men, low testosterone levels are associated with an increased risk of osteoporosis. NICE has estimated one in three women and one in five men will sustain a fracture in their lifetime.[7]

2. Functions and operation of fracture liaison services

In addition to some patients being identified in primary care settings, like GP surgeries, fracture liaison services (FLSs) proactively identify people with a risk of osteoporosis.[8] FLSs are commissioned by local integrated care boards.

An FLS contacts patients aged 50 and over with a fragility fracture to check their bone health and falls risk, with the goal of lowering their risk of a subsequent fracture. The ROS has highlighted that around 50% of people who experience a hip fracture have previously broken a bone.[9]

Services are usually led by specialist nurses or other health professionals who provide a clinical assessment, often including a bone density scan, and then provide treatment options and information to patients.[10]

3. Quality and coverage of fracture liaison services

The ROS has observed there is 100% FLS coverage across Scotland and Northern Ireland.[11] In addition, the Welsh government set and met a target for full FLS coverage by September 2024.[12] Coverage remains partial in England, though the UK government has set an ambition for full coverage by 2030.[13]

The Royal College of Physicians maintains the FLS database, which has monitored the performance of FLSs since 2016.[14] Looking at data submitted by 69 services across England and Wales in 2023, the 2025 annual report found increases in the number of FLSs identifying spine fractures and patients receiving an FLS assessment within 90 days.[15] However, it said the number of scans provided within 90 days remained low, as did monitoring rates. The report also noted regional variations in fracture identification rates.

The ROS has highlighted that monitoring and follow up are key to patients staying on treatments.[16] Patients report finding it challenging to keep taking common osteoporosis medications, because they must be taken in a particular way and can cause side effects. At the same time, patients do not feel ‘better’ from taking them: they reduce long-term fracture risk rather than addressing any current symptoms.[17]

The FLS database also includes a dashboard, as part of the ‘Falls and fragility fracture audit programme’, including the latest available statistics against key performance indicators.[18] On 30 September 2025, the dashboard estimated that 36.9% of patients in England who had an initial non-spinal fracture were being reached.[19] It noted this was below a target ‘green’ rating of 80% or more.

Access to diagnostic services also varies by region. The APPG on Osteoporosis and Bone Health attributed this to a shortage of DEXA (dual energy X-ray absorptiometry) bone density scanners and radiographers.[20] In the latest NHS England figures, for July 2025, 56,674 patients were waiting for a DEXA scan. This is fewer people than the same month in 2024 (57,781). Of the July 2025 waiting list, 13.6% had been waiting more than the targeted six weeks.[21] This is down from 19.9% in July 2024.

4. Campaigns for 100% coverage for fracture liaison services

The ROS, the Express and the Mail on Sunday have all been campaigning for 100% coverage of FLSs in England.[22]

The ROS estimated that £30mn of investment in FLSs could prevent 74,000 fractures, including 31,000 hip fractures, over five years.[23] The ROS said, “This would save the NHS £665mn and release 750,000 bed days”. It is also calling for improvements in quality and the appointment of a national clinical director to lead the improvement programme.

The campaigns follow two reports by the APPG on Osteoporosis and Bone Health: ‘How to end the postcode lottery for access to a quality fracture liaison service’ (2021) and ‘Fracture prevention and osteoporosis in primary care’ (2022).

As well as advocating for 100% FLS coverage, the 2022 report concluded that people were having to “battle to access the care they needed”:

People struggled to access GP appointments, investigations, scans and specialist advice. Many reported having to go private to get the provision they expected from primary care.[24]

The report recommended the national screening committee reconsider the case for a targeted national screening programme to detect high fracture risk, citing the focus on prevention in the NHS long term plan.[25] The national screening committee decided against screening for osteoporosis in all post-menopausal women in 2019.[26]

Other recommendations in the APPG’s 2022 report on fracture prevention included a public health campaign about bone health, expansion of DEXA services to tackle current backlogs and future-proof services, and personalised ‘bone health management plans’ for identified patients, with a specified timescale for reviews.[27]

5. Previous government policy

In the 2022 ‘Women’s health strategy for England’ there was a commitment to “a greater focus on identifying those at particular risk [of osteoporosis and fragility fractures], and on both primary and secondary prevention, thereby addressing the treatment ‘gap’ that exists currently”. In a January 2024 statement about progress on implementing the women’s health strategy, the then government said osteoporosis would be factored into a major conditions strategy.[28]

The government’s call for evidence for the major conditions strategy closed on 27 June 2023.[29] It sought views on “how best to prevent, diagnose, treat and manage six major groups of health conditions that most affect the population in England”, including musculoskeletal disorders. However, the major conditions strategy was not published before the change of government at the 2024 election.

In May 2024, then secretary of state for health and social care Victoria Atkins had said the government would work towards 100% FLS coverage:

I have listened to the tireless campaigning of the Royal Osteoporosis Society and the campaigns of the Express and the Mail on Sunday, so today I want to confirm that this government have the ambition to expand the use of fracture liaison services to every integrated care board in England and achieve 100% coverage by 2030.[30]

6. Current government policy

In June 2024, Wes Streeting (then shadow health secretary) told the Mail on Sunday that Labour would also aim for 100% coverage in England by 2030.[31] Mr Streeting committed to FLSs “right across the country”. He said, “All the evidence shows earlier diagnosis means faster treatment and better outcomes for patients”. At a September 2024 party conference fringe event, he said, “We’ve made the promise, and now we will keep the promise”.[32]

In the autumn 2024 budget, the government pledged funding for NHS technology and digital improvements, as well as diagnostic tests.[33] Craig Jones, CEO of the ROS, said the additional funding meant there was now “no excuse for Mr Streeting not to honour his commitment to roll-out these life-saving osteoporosis services nationally”.[34]

In January 2025 the government published a plan on ‘Reforming elective care for patients’, which said NHS England would “boost bone density scanning (DEXA) capacity by investing in up to 13 DEXA scanners to support improvements in early diagnosis and bone health, particularly in the highest priority locations”. The government estimated this would provide 29,000 extra bone scans per year. Six of the scanners are replacing existing machines, while others will provide “new or extended DEXA services”.[35] The government confirmed the rollout in May 2025.

While the Society of Radiographers welcomed the additional scanners, it said workforce shortages and a lack of training capacity could limit the number of additional people receiving scans.[36]

In July 2025 the government published its 10-year health plan, which repeated its commitment to 100% FLS coverage by 2030. The plan said that FLSs could be located in neighbourhood health centres (NHCs).[37] The government said its aim was to have an NHC “in every community” providing a range of locally coordinated healthcare services.

In response to written questions about progress towards the 100% target, the government has repeated its commitment while noting that FLSs are commissioned by integrated care boards rather than directly by government.[38]

6. Read more

Cover image by Harlie Raethel on Unsplash.

References

  1. UK Parliament, ‘Lord Black of Brentwood: APPG officer roles’, accessed 29 September 2025; and ‘Register of all-party parliamentary groups (as at 9 September 2025): Osteoporosis and bone health’, accessed 29 September 2025. Return to text
  2. National Institute for Health and Care Excellence, ‘What are osteoporosis and osteoporotic fractures?’, April 2025. Return to text
  3. National Institute for Health and Care Excellence, ‘Osteoporosis: How common is it?’, April 2025. Return to text
  4. Royal Osteoporosis Society, ‘Effective secondary prevention of fragility fractures: Clinical standards for fracture liaison services’, August 2019. Return to text
  5. NHS, ‘Osteoporosis: Causes’, 13 October 2022. Return to text
  6. National Institute for Health and Care Excellence, ‘Osteoporosis: How common is it?’, April 2025. Return to text
  7. As above. Return to text
  8. Royal Osteoporosis Society, ‘Fracture liaison services’, accessed 12 September 2025. Return to text
  9. Royal Osteoporosis Society, ‘Effective secondary prevention of fragility fractures: Clinical standards for fracture liaison services’, August 2019, p 2. Return to text
  10. Laurna Bullock et al, ‘Developing a model fracture liaison service consultation with patients, carers and clinicians: A Delphi survey to inform content of the iFraP complex consultation intervention’, Archives of Osteoporosis, 24 March 2021, vol 16, issue 58. Return to text
  11. Royal Osteoporosis Society, ‘ROS calling for better fracture liaison service funding after research shows scale of ‘postcode lottery’ facing patients’, 18 August 2021. Return to text
  12. Welsh Government, ‘Written statement: Fracture liaison services rolled out across Wales’, 30 September 2024. Return to text
  13. Royal College of Physicians Fracture Liaison Service Database, ‘Annual report 2025’, January 2025; and Royal Osteoporosis Society, ‘Wes Streeting: ‘We made the promise, we’ll keep the promise’ on universal fracture liaison services by 2030’, 24 September 2024. Return to text
  14. Royal College of Physicians, ‘The fracture liaison service database (FLS-DB)’, accessed 16 September 2025. Return to text
  15. Royal College of Physicians Fracture Liaison Service Database, ‘Annual report: You’ve had a fracture; how can we prevent another? (Data from 1 January 2023–31 December 2023)’, January 2025, p 5. Return to text
  16. Royal Osteoporosis Society, ‘ROS calling for better fracture liaison service funding after research shows scale of ‘postcode lottery’ facing patients’, 18 August 2021. Return to text
  17. F Fatoye et al, ‘Real-world persistence and adherence with oral bisphosphonates for osteoporosis: A systematic review’, BMJ Open, 2019, issue 9. Return to text
  18. Royal College of Physicians, ‘Fracture liaison service database’, accessed 16 September 2025. Return to text
  19. The database is subject to updates therefore this figure will change over time. For the latest estimate see the column titled ‘KPI 2 non-spine case identification’. Return to text
  20. Royal Osteoporosis Society, ‘All-Party Parliamentary Group on Osteoporosis’, accessed 16 September 2025. Return to text
  21. NHS England, ‘Monthly diagnostics data 2025–26’, accessed 19 November 2024. Return to text
  22. Jaymi McCann, ‘Sunday Express’s better bones campaign aims to aid 1,000s suffering from osteoporosis’, Express, 13 April 2024; and Charlotte Bend, ‘Health Secretary Wes Streeting pledges to ‘keep his promise’ over commitment to end the postcode lottery of vital bone scans’, Mail Online, 29 September 2024. Return to text
  23. Royal Osteoporosis Society, ‘Campaign for early diagnosis services in every area’, accessed 16 September 2025. Return to text
  24. All-Party Parliamentary Group on Osteoporosis and Bone Health, ‘Fracture prevention and osteoporosis in primary care’, 2022, p 6. Return to text
  25. As above, p 8. Return to text
  26. UK National Screening Committee, ‘Adult screening programme: Osteoporosis’, 2019. Return to text
  27. All-Party Parliamentary Group on Osteoporosis and Bone Health, ‘Fracture prevention and osteoporosis in primary care’, 2022, p 8. Return to text
  28. House of Commons, ‘Written statement: Women’s health strategy (HCWS192)’, 17 January 2024. Return to text
  29. Department of Health and Social Care, ‘Major conditions strategy: Call for evidence’, 17 May 2023. Return to text
  30. HC Hansard, 23 May 2024, col 1045. Return to text
  31. Anna Mikhailova, ‘Wes Streeting reveals his personal vow to tackle the bone scan postcode lottery crisis in the NHS’, Mail Online, 2 June 2024. Return to text
  32. Royal Osteoporosis Society, ‘Wes Streeting: ‘We made the promise, we’ll keep the promise’ on universal fracture liaison services by 2030’, 24 September 2024. Return to text
  33. HM Treasury, ‘New funding to fix the NHS: Here’s how it will be spent’, 30 October 2024. Return to text
  34. Royal Osteoporosis Society, ‘With surge in NHS funding, there’s “now no excuse” not to fund bone clinics Wes Streeting said would be “one of first acts in post”’, 30 October 2024. Return to text
  35. Department of Health and Social Care, ‘More scanners across the country for better care of brittle bones’, 12 May 2025. Return to text
  36. Society of Radiographers, ‘Delivery of 29,000 more bone scans per year could be hindered by workforce shortages, says SoR’, 12 May 2025. Return to text
  37. Department of Health and Social Care, ‘10 year health plan for England: Fit for the future’, 30 July 2025, p 36. Return to text
  38. For example, House of Commons, ‘Written question: Fractures: South West (30340)’, 13 February 2025; and House of Commons, ‘Written question: Fractures: Health Services (25074)’, 29 January 2025. Return to text