Invest in Your Bones is a pan-European campaign led by the International Osteoporosis Foundation (IOF).

Five countries are currently involved including the UK. Within each country, key stakeholders from various societies/charities and pharmaceutical partners have come together under the umbrella of the IOF ‘Invest in Your Bones’ Campaign. The main societies in the UK include the National Osteoporosis Society (NOS), the British Orthopaedic Association (BOA), the British Geriatrics Society (BGS), the Royal College of General Practitioners (RCGP) and the European Society for Musculoskeletal Radiology (ESSR).
Three key areas have been identified for implementation throughout the UK :

1. National Policy / Political Lobbying Initiative
2. Orthopaedic Surgeons Initiative
3. Radiologist Vertebral Fracture Initiative

National Policy/ Political Lobbying Initiative key messages:

• Provide for adequate DXA provision for effective management of patients with osteoporosis
• Improve resources and funding to ensure the government directives are implemented
• Speed up progress in the implementation of government policies such as the NSF for Older People in England, SIGN in Scotland and Osteoporosis strategy document in Wales

Orthopaedic Surgeons Initiative

• Orthopaedic surgeons need to take an active role in identifying patients with fragility fractures and implement secondary prevention strategies
• An effective model for fragility fracture prevention is Fracture Liaison Service (FLS)
• FLS /FL nurses should be implemented in all UK Trusts

Radiologist Vertebral Fracture Initiative

• Many vertebral fractures are not being identified or reported
• Most vertebral fractures are osteoporotic in origin and constitute a strong risk factor for future fractures
• Action is needed by radiologists to ensure that vertebral fractures are recognised and reported

The link with the BGS is through the Falls and Bone Health Section of the Society and this has led to the development of several key collaborations, policies, national training courses, and will continue to grow.

One of the major advances from the Vertebral Fracture Initiative has been the development of the ‘Educational CD for Radiologists’ which incorporates resource document, summary handout and slide kit, aimed at improving the recognition and reporting of vertebral fractures.

Vertebral fractures are the most common type of osteoporotic fracture. They can occur with no, or minimal, trauma. Clinical symptoms of vertebral fractures include back pain, loss of height, deformity, disability and limited spinal mobility, and there is associated increased mortality. With a single vertebral fracture there is a 12% increased risk of a future vertebral fracture within 12 months; with multiple vertebral fractures this risk rises to 22%. Patients with vertebral fracture are at a 5-fold increased risk of further vertebral fractures, and at 2-fold increased risk of hip fracture. Consequently, the accurate identification of vertebral fracture has a vital role to play in the diagnosis and management of patients with osteoporosis.

Vertebral fractures may be symptomatic, but between 30% - 75% may be asymptomatic fracture, and not come to clinical attention. Many older patients with vertebral who do come to clinical attention do so for other reasons and may have incidental fractures seen on plain chest x-rays in particular, when lateral chest radiographs are requested, but the vertebral fracture(s) are completely overlooked (think of your last x-ray meeting!). There is evidence that a significant number (30%-50% or more) of vertebral fractures presenting on radiographs are not reported, or if they are reported, their significance is not recognised by clinicians requesting the x-ray.

The CD enclosed with the printed version of newsletter has been developed as an educational tool to help clinicians improve the recognition and understanding of the importance of vertebral fractures in elderly patients.

Opinder Sahota DM, FRCP, ILTM (BGS)
Judith E Adams MBBS, FRCR, FRCP (ESSR)