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The Northern Bone Health Project

Dr Sunil Nedungayil, associate medical director for the Healthy Ageing Programme at Northern Health Science Alliance, explains how he is using research to drive improvements in bone health for patients in the north of England.

What problem are we trying to solve? 

Falls, fragility fractures and osteoporosis are often underdiagnosed and underestimated, especially in primary care.(1) They lead to a significant loss of healthy life years and have a massive impact on patients’ quality of life and the health and social care economy.(2) The mechanism for identifying these patients in primary care is unfortunately, not robust. The north of England in particular, has the highest rate of emergency admissions for hip fracture in people aged 65 and over, significantly above the national average.(3) 

How will our project work? 

The project is designed as a ‘proof of concept’ to provide evidence for a future-proof sustainable model of fragility fracture reduction in primary care. This bone health programme focuses on case finding, fracture risk assessment, primary and secondary fragility fracture prevention, medication optimisation and patient education. We will scrutinise the electronic patient records in primary care using software algorithms for case-finding and risk stratification. This work will be carried out on-site at the GP practice, or remotely, by a clinical pharmacist. We will advise on medication optimisation, patient education and non-pharmacological interventions in line with local and national guidance. Primary care teams will be assisted to develop their own multidisciplinary bone health teams.

The proactive, standardised methodology of primary and secondary fracture prevention in primary care will add synergy to existing bone health programmes like the Fracture Liaison Service, and help evolve a whole system approach to bone health improvements. Forty-eight practices within the four Academic Health Science Network (AHSN) geographical areas – the North West Coast, Greater Manchester, North East & North Cumbria and Yorkshire & Humber are currently in various stages of project recruitment and implementation. The project will then report on its findings in 2021.

What benefits will this project deliver? 

Current national guidance provides evidence that effective case finding and use of appropriate drug therapies reduces the risk of future clinical fractures by up to 50%.(4)  

Two studies in the north of England have demonstrated that a population-based approach to improve the detection and management of fragility fractures in primary care, can provide value for money. The pilot studies demonstrated the efficiencies in using the digital platform for case-finding and risk stratification and the return of investment in primary and secondary prevention approaches to fragility fractures.(1,5) Sizeable direct and indirect costs can be saved in the health and social care system while improving the wellbeing of people living in our communities and those who care for them.(5) 


  1. Population screening to risk stratify and target primary prevention measures for osteoporosis in primary care in UK - a feasibility study. Nedungayil S et al.
  2. Royal College of Physicians. National Hip Fracture Database commissioners’ report 2015. London: RCP, 2015. 
  3. Public Health Outcomes Framework Data tool. 
  4. National Institute for Health and Care Excellence Osteoporosis: Assessing the risk of fragility fracture. Clinical guideline CG146. London: NICE, 2012.
  5. National Institute for Health and Care Excellence shared learning database. Bone Health Programme: A proactive population approach to bone health. NICE, October 2017.