Let The First Fragility Fracture be the Last!

Aneurin Bevan University Health Board

Introduction:

Osteoporosis is a silent public health crisis, leading to over 300,000 fragility fractures annually in the UK. In Aneurin Bevan University Health Board (ABUHB), only 23.4% of fragility fractures were identified in 2021, far below the national standard. Given the high personal, clinical, and financial cost, the Fracture Liaison Service (AB-FLS) aimed to improve case identification to 60% by 2024 and ensure that the first fragility fracture would be the last.

Methods:

Since 2015, the AB-FLS team employed a Quality Improvement (QI) approach using multiple Plan-Do-Study-Act (PDSA) cycles. Efforts included systematic case finding via radiology reports, collaboration with primary care, dementia audits, and CT scans. In 2022, AB-FLS introduced a digital system that scanned radiology reports weekly using the keyword “fracture,” enabling Bone Health Nurses to triage potential fragility cases directly. Multidisciplinary collaboration with radiologists, clinicians, IT teams, and management ensured system integration, workforce development, and data tracking.

Outcomes:

• Fragility fracture case-finding rose 200%, from 22.7% in 2021 to 70% in 2024 - surpassing national benchmarks

• Automated detection of fractures from X-ray, CT, and MRI now enables earlier diagnosis and care

• Treatment and follow-up rates tripled, with 66% of patients treated and 46% followed up at 16 weeks

• Equitable care prioritised, with improved access for older, frail, and underserved groups

• The model is being scaled across Wales, with a 48% year-on-year rise in fracture identification

Environmental and social benefits include reduced patient travel, equitable care for older adults, and improved public awareness through YouTube education and community outreach.

Learnings:

Success came from digital innovation, early stakeholder engagement, and strong clinical leadership. Patient stories, PROMs, and digital tools reinforced person-centred care. Earlier dissemination and broader third-sector collaboration could have enhanced reach.

What next?

AB-FLS is piloting pharmacist roles, streamlining clinic workflows, and promoting national spread. With Ministerial support, Wales became the first UK nation to mandate universal FLS. Work now focuses on achieving 80/50/80 standards and shifting towards primary fracture prevention.