Bone Abstracts

Background: Commissioning prioritisation is a strong driver of effective resourcing of Fracture Liaison Services (FLSs). While the impact of hip fracture emergency admissions is known, how this compares to other medical conditions is less well understood. We describe unplanned bed days for femoral and non-femoral fractures among the top 15 diagnoses across NHS trusts in England.

Method: We calculated total bed days between April 2024 and March 2025 for adults aged ≥50 years using Hospital Episode Statistics Finished Consultant Episode (FCE) data for England. Primary ICD-10 admission codes were used to identify femur and non-femur fractures (S72 Fracture of femur; S22 Fracture of rib(s), sternum and thoracic spine; S42 Fracture of shoulder and upper arm; S82 Fracture of lower leg, including ankle; S52 Fracture of forearm; M80 Osteoporosis with pathological fracture; S62 Fracture at wrist and hand level). We then identified the top 15 diagnosis codes for emergency admissions, excluding mental health, obstetric and gynaecological conditions. Admission costs for each ICD-10 code were calculated as the total tariff for emergency admission spells with the diagnosis in the primary position. Admission volumes and costs were compared with aggregated bed days and costs for the top 15 diagnoses.

Results: Across 118 NHS Trusts in England, femur fractures accounted for 1,310,350 emergency admission bed days and non-femur fractures for 905,775, totalling 2.2 million bed days. This compares with 14.7 million bed days across the top 15 emergency admission diagnoses. Corresponding costs were 731,032,710 for femur fractures and 342,886,989 for non-femur fractures, totalling 1,073.9 million, compared with 6,262.4 million across the top 15 diagnoses. Nationally, femoral and non-femoral fractures represented 15.1% of top 15 emergency admission bed days and 17.2% of costs within the top 15 diagnostic groups.

Conclusion: Femoral and non-femoral fractures account for over 15% of total emergency admission bed days and costs across the top 15 diagnostic groups, supporting the central prioritisation of fracture prevention services such as FLSs. Further work is needed to describe these data at the Trust level to inform local prioritisation of FLS commissioning.