Devastating “postcode lottery” for osteoporosis medication - study reveals 69% of patients experience problems getting vital treatments

More than a million women are being overlooked for life-saving osteoporosis treatments – with people in deprived areas worst hit - because of a “chaotic patchwork of prescribing”, a new study has found.

The report published by the All-Party Parliamentary Group (APPG) on Osteoporosis and Bone Health, which the Royal Osteoporosis Society provides the secretariat for, said that 69% of patients experience problems accessing medication.

It highlighted the “critical need for systemic reform” to tackle the barriers to osteoporosis medication in the NHS, which is leaving millions of people at risk of life-threatening broken bones.

The review, carried out by the Royal Osteoporosis Society on behalf of the APPG, found that the vast majority (69%) of patients with osteoporosis have experienced problems with being prescribed medication for the condition, with people living in deprived areas much more likely to face additional barriers.

Drug treatments for osteoporosis are highly effective at stopping bones breaking. However, the review shows that current osteoporosis treatment rates are extraordinarily low, with just 31% of patients starting treatment within four months of diagnosis and only 14% remaining on the drug after one year.

Uncovering a postcode lottery, it found that the ability to access osteoporosis treatment is dependent on a person’s address. While people living in particular areas can receive their medication from a GP, others require a specialist referral for the same drug or find that the treatment is unavailable in their region.

The new analysis shows:

• 4 million women that should be eligible for romosozumab, a new and groundbreaking “bone-builder” treatment, are unable to access the medication, leaving them at high risk of broken bones.
• 25 million women that should be eligible for denosumab, a six-monthly injection typically offered to people who experience difficulties with more common bone drugs, face significant barriers due to their location.

The report shows prescribing rates of the most common osteoporosis treatments, such as ibandronate, are significantly lower than in affluent areas. Currently, over 1 million women who are eligible for ibandronate live in an area where their GP is unable to prescribe it. People in deprived areas are also much less likely to be able to access denosumab without further referrals and delays.

The report also details significant gaps in osteoporosis expertise amongst clinicians, with some primary care professionals unwilling to prescribe alternative treatments for those experiencing side effects from their current medication.

According to the ROS, 80% of the 14,000 calls every year to their specialist nurse helpline are from people who are confused about their medication options.

Preventable fractures as a result of osteoporosis are estimated to cost the NHS £4.5 billion each year, with one million acute hospital bed days taken up by hip fracture patients alone.

The report states: “Our evidence shows how a chaotic patchwork of drug prescribing rules is leading to inequity and inefficiency.”

It adds: “A postcode lottery currently determines whether people get access to osteoporosis medications.”

The report calls for a “unified approach, involving a clear patient pathway”, which would ensure “quality care for everyone, regardless of their postcode”.

 “The review underscores the critical need for systemic reforms to address the inequities and inefficiencies in osteoporosis treatment,” said the report.

Craig Jones, Chief Executive at the Royal Osteoporosis Society (ROS) said: “This report shows there’s a wild west when it comes bone drugs in the NHS, which is endangering lives. The chaotic patchwork of prescribing practices across the UK is costing tens of thousands of people the treatments they desperately need to stay safe and well. Wes Streeting’s pledge to roll-out fracture clinics offers a chance to straighten out this mess, without which we’ll see a tsunami of demand engulf our NHS and social services – with the pressures spiralling every year the population ages.”

Sonia Kumar, MP for Dudley and Co-Chair of the APPG on Osteoporosis and Bone Health, said: "This report comes at vital time. The commitment from the Secretary of State for Health and Social Care to end the Fracture Liaison Services postcode lottery and roll out coverage nationally provides a rare and exciting opportunity.

“With universal early diagnosis services alongside equal access to bone-strengthening medicine, we can transform the lives of millions of people with osteoporosis across the UK, saving the NHS and social care vast sums of money, and help our economy grow.”

Health Secretary Wes Streeting has promised to roll-out Fracture Liaison Service (FLS) to all parts of England by 2030, which would help even out people’s access to medication and end this postcode lottery. Currently only half of NHS trusts have an FLS.

The ROS is setting up the new BoneMed Online service, offering tailored information to support people with their osteoporosis treatment journey, to help patients feel supported and motivated to stay on treatment, which is proven to reduce the risk of further fractures.

Read the full APPG report here