Bone Abstracts

Background: This audit evaluates the Enfield Community FLS, specifically patients referred from the North Middlesex University Hospital (NMUH) to benchmark performance against the National Osteoporosis Guideline Group (NOGG 2024) and the Royal Osteoporosis Society clinical FLS standards (ROS 2019).

Methods: A retrospective audit of 37 patients over a twelve-month period who interfaced with both NMUH and Enfield FLS. Data were extracted from the FLS caseload and measured against ROS and NOGG quality benchmarks, specifically the 16-week target for treatment initiation.

Results: Mean patient age was 68.3 years; 86.5% (32/37) were female. Vertebral fractures accounted for 27.0% of cases, wrist (27.0%) and humerus (21.6%) fractures. Notably, 27% had BMD values in the non-osteoporotic range, emphasising the importance of fracture-based risk assessment beyond T-scores. High-risk stratification led to Rheumatology referral in 64.9% (24/37). Although 62.1% had a documented treatment plan, mean time to review was 99.6 days, placing patients requiring parenteral or osteoanabolic therapies at high risk of breaching ROS 16-week standards.

Conclusion: The community-based Enfield FLS provides a holistic MDT model to support secondary fracture prevention. This aligns with the NHS 10-Year Health Plan (2025) with the dual mandate to shift care from "hospital to community" and from "sickness to prevention". The Advice and Guidance pathway enables secondary care inreach, however it cannot alone mitigate underlying capacity issues; rising case-finding and the use of osteoanabolics will inevitably increase demand for Rheumatology input. Proactive planning is needed to enable timely access to osteoanabolic therapies and reduce the risk of recurrent fractures and associated morbidity and mortality delivering on the national promise of proactive, community-based preventative care.

References: 1. Department of Health and Social Care (2025) Fit for the future: 10 Year Health Plan for England. 2. National Osteoporosis Guideline Group (NOGG) (2024) Clinical guideline for the prevention and treatment of osteoporosis. 3. Royal Osteoporosis Society (2019) Effective secondary prevention of fragility fractures: Clinical standards for fracture liaison services.