New North project to prevent fractures could save NHS £35m

AN innovative new approach to reduce the risk of older people breaking bones could save the NHS over £35 million, across the North of England, if it is fully scaled-out across the region.

3rd April 2019

AN innovative new approach to reduce the risk of older people breaking bones could save the NHS over £35 million, across the North of England, if it is fully scaled-out across the region.

The project will identify patients at high risk of breaking bones, evaluate medications and treat those patients, where appropriate, with a bone-sparing agent to improve bone density.

Scaled up to the population level of the North’s 16 million, this would equal £35,163,642 in direct costs and £8,454,046 in residential costs – a total of £43,617,688 potential savings in health and social care.

The project has been developed and tested by the AHSN NENC and the Innovation Agency (AHSN for the North West Coast). Now all four AHSNs across the North including Greater Manchester and Yorkshire and Humber are implementing the project.

The Northern AHSNs will be working in partnership with AMGEN, The Northern Health Science Alliance (NHSA) and Interface to deliver the approach to targeting fracture risk assessment and bone-sparing medication review at a Primary Care level.

The project is scheduled to run for one year and designed as a ‘proof of concept’ to provide the evidence for a future-proof sustainable model of fracture reduction.

Dr Sunil Nedungayil, Principal GP at The Castle Medical Group Clitheroe and GP with Special Interest in Musculoskeletal Medicine at the Integrated MSK, Pain & Rheumatology Service (IMPReS) said: “By preventing fractures, pain and disability, this project aims at improving the quality of life of patients and their independence. It will enable them to make valuable contributions to their communities and the economy as a whole.”

Dr Iain Goff, Consultant Rheumatologist at Northumbria Healthcare Trust said: “In North Tyneside, the bone health project has provided an informative and insightful look into the current practice in our region around management of fracture risk. The level of detail has helped us make informed decisions across primary and secondary care, and the clinical leadership shown by the pharmacy team has been outstanding.”

Sue Hart Health Programme Manager AHSN NENC said: “In the North East & North Cumbria we have recently completed a large population based, risk factor assessment incorporating almost 600,000 patients.

“Our study identified many opportunities, both simple and large scale to ensure that all patients identified receive the gold standard care recommended by National Guidance. This proposed programme offers the North of England a valuable opportunity to adopt and spread the learning from NENC, enabling the delivery of better patient care and improved cost efficiencies.”

Nicola Wilson Interim CEO of the Northern Health Science Alliance said: “We are delighted to offer our support to this innovative and ground-breaking Northern project which will see a huge amount of benefit for both patients and the national health and social care services.

“As the NHS looks increasingly towards prevention, the Bone Health Project demonstrates the savings to people’s health and to NHS budgets that can be made from taking an intelligent preventative approach.”

Falls and fractures are a common and serious health issue faced by older people in the UK. Every year, there are around 255,000 falls-related emergency hospital admissions in England among patients aged 65 and older.

Falls are estimated to cost the NHS more than £2.3bn a year and the annual total cost of fragility fractures to the UK has been estimated at £4.4bn[1]. 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%. [2]



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The NHSA ltd is a partnership established by the leading Universities and NHS Hospital Trusts in the North of England to improve the health and wealth of the region by creating an internationally recognised life science and healthcare system. It links eight universities and eight research-intensive NHS Teaching Trusts with four Academic Health Science Networks (AHSNs) covering a population of over 16 million.

The NHSA’s members include: Newcastle University, Durham University, University of York, University of Liverpool, University of Manchester, Lancaster University, University of Sheffield, Sheffield Hallam University, University of Leeds, University of Central Lancashire, The Newcastle Upon Tyne Hospitals NHS Trust, South Tees Hospitals NHS Trust, Leeds Teaching Hospitals, Sheffield Teaching Hospitals, Rotherham, Doncaster and South Humber NHS Foundation Trust, Manchester University NHS Foundation Trust, The Royal Liverpool and Broadgreen University Hospitals, Hull and East Yorkshire Hospitals, Lancashire Teaching Hospitals, Innovation Agency AHSN, Yorkshire and Humber AHSN, North East North Cumbria AHSN, Health Innovation Manchester.
For more information on the NHSA visit


The AHSN NENC, in joint-working with AMGEN and Interface Clinical Services, has demonstrated that this is a cost-effective project. In 71 practices with a population of 579,508 there are 13,848 (9%) of patients with a fracture risk above the upper intervention threshold recommended for treatment, 10,611 (77%) were not on bone sparing therapy.

By treating all 10,611 patients over a 3-year period with a bone-sparing agent at a cost of £468,900:

  • 274 fractures could be prevented;
  • £1,274,045 could be saved in direct costs due to prevented fractures; and
  • £328,143 could be saved in residential/nursing home costs due to prevented fractures.

What are the expected outcomes?

  1. To maximise the number of patients identified as at risk of fragility fracture
  2. To maximise the number of patients assessed for suitability for treatment with bone-sparing medication
  3. To maximise the number of eligible patients initiated on bone-sparing medication
  4. To maximise the number of eligible patients receiving interventions other than bone-sparing medication in order to reduce the risk of a fragility fracture
  5. To improve the recording of information about patients with osteoporosis and prior fragility fracture in primary care


  1. Photo: Project Steering Group (from left to right)

Front row: Karly Hoggard (National Account Manager, Interface Clinical Services), Nicki Wilson (Interim Chief Executive, the NHSA), Sue Hart (Health Programme Manager, AHSN for North East and North Cumbria), Lisa Butland (Programme Associate, the NHSA and Chief Executive Age UK Calderdale and Kirklees), Dr Sunil Nedungayil (Clinical Champion and GP Principal, The Castle Medical Group), Dr Dai Roberts (Senior Programme Development Lead, Health Innovation Manchester)

Back row: Natalie Tuzcuoglu (NHS Value Solutions Manager, AMGEN), Andrew Cooper (Associate Director for Patient Safety, The Innovation Agency), [name and role title] (Yorkshire and Humber AHSN), Jack Birchall (Head of Service Development, Interface Clinical Services)


[1] Public Health England. Falls and Fragility Fracture Consensus Statement: Supporting commissioning for prevention. January 2017.

[2] National Institute for Health and Care Excellence (2012). NICE Clinical Guideline 146. Osteoporosis: Assessing the Risk of Fragility Fracture.

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