Bone Abstracts

Background: Primary care plays an essential role in the identification, investigation, and management of people with, or at risk of, osteoporosis. Despite the availability of evidence-based clinical guidelines, an osteoporosis care gap exists, with many individuals at high risk of fragility fracture going unidentified or untreated. Incorporating the perspectives of people with lived experience in research is essential to ensure that service improvements reflect patient priorities and address real-world barriers to care. We aimed to co-design a set of evidence-based recommendations in collaboration with public contributors to improve osteoporosis care in primary care settings.

Methods: A Research User Group (RUG), comprising members of the public with lived experience of osteoporosis and/or fragility fracture, informed a programme of research exploring barriers to and enablers of evidence-based osteoporosis practice in UK primary care. This included a scoping review of qualitative literature, a national e-survey (n341) and semi-structured interviews (n16) with primary care professionals. Findings were synthesised and discussed over five meetings, with a sixth meeting convened to co-design a set of recommendations aimed at improving the delivery of osteoporosis care in primary care settings.

Results: Ten recommendations outline system-level actions needed to strengthen osteoporosis care within the NHS. Key priorities include increasing the visibility of osteoporosis within national health policy, introducing aligned financial incentives and quality indicators, and embedding systematic digital case-finding approaches within electronic health records. Recommendations also emphasise the importance of integrating primary and secondary care pathways, strengthening audit and feedback mechanisms, improving the accessibility and implementation of clinical guidance, and embedding digital decision-support tools. Additionally, recommendations highlight the need for targeted education and training for primary care professionals, clearer roles for multidisciplinary team members, and improved access to health literacy friendly patient information to support shared decision-making.

Conclusion: The ten co-designed recommendations highlight priorities for improving osteoporosis care in primary care. They provide accessible, patient-informed guidance for policymakers, primary care organisations, charities and clinicians seeking to close the osteoporosis care gap. The recommendations have been shared with the Royal Osteoporosis Society, with potential to inform future policy and advocacy work, including contributions to All-Party Parliamentary Group activity on osteoporosis.