Bone Abstracts

As one of the three key shifts in the NHS long term plan, the UK has renewed interest in the importance of shifting from treatment to prevention. Osteoporosis is an exemplar condition where there are significant missed opportunities for prevention. Osteoporotic fractures represent a major public health burden, causing substantial morbidity, loss of independence, and healthcare costs. Although effective treatments exist and clinical guidelines recommend assessment of people at increased fracture risk, large care gaps remain. Fewer than 40% of those at elevated risk currently receive recommended assessment or treatment, with particularly marked inequities affecting men, people living with dementia, individuals from minoritised ethnic backgrounds, and those experiencing socioeconomic deprivation. Terms such as screening and targeted case finding are often used interchangeably, despite conceptual and practical differences. This presentation will explain these definitions and explore how they relate to contemporary primary care practice. The principles underpinning screening programmes will be discussed, including the importance of the condition, the availability of effective treatment, the accuracy and acceptability of tests, and evidence that earlier identification improves outcomes. Implementation requires careful consideration of benefits, harms, opportunity costs, equity, and the capacity of healthcare systems to act on identified risk. This presentation will review current evidence relating to screening and case identification for people at increased risk of osteoporotic fractures in primary care. The second half of the talk will introduce the NIHR-funded PROTECTS (PRevention of Osteoporotic fractures Through Equitable Case finding and Treatment Support) programme, a six-year programme grant designed to develop and evaluate a new approach to fracture prevention in UK primary care. PROTECTS combines automated identification of people at increased fracture risk using electronic health records, implementation support for general practices, and decision-support resources for patients and clinicians. A central focus is ensuring equitable access to assessment and treatment, particularly for underserved populations. The programme will generate evidence on feasibility, implementation, effectiveness, and cost-effectiveness, with the ultimate aim of informing future models of proactive, data-enabled prevention in primary care.