Inequality in secondary fracture prevention supports prioritisation of fracture liaison services in coastal health plans in England and Wales

Summary The 2021 UK Chief Medical Officers' annual report highlighted poorer health in coastal communities but did not include osteoporosis or secondary fracture prevention. Using Fracture Liaison Services database (FLS-DB) data, FLSs in coastal areas were shown to have poorer performance and lower parenteral osteoporosis medication recommendation rates, supporting inclusion of FLSs in coastal health improvement plans. A number of studies have highlighted socio-economic deprivation as a predictor of fragility fractures and poorer outcomes after fracture. In parallel, coastal areas are recognised to be areas with poorer health outcomes, in part due to socio-economic deprivation. Purpose To describe secondary fracture prevention in terms of FLS provision and quality in coastal vs. non-coastal healthcare settings using routinely collected audit data. Methods A cross-sectional, ecological analysis using the missed opportunity counts from the national Fracture Liaison Service (FLS-DB) and Hip Fracture (NHFD) Databases of England and Wales audit data with Office for National Statistics classification of coastal towns. Results Results Coastal sites were not significantly more likely to be non-FLS vs FLS providers (38% vs 24%, p = 0.18). However, coastal FLSs had higher missed opportunity patient counts than non-coastal FLSs ( p = 0.02), with lower vertebral identification rates (14.2% vs 20.9%, p = 0.02). While treatment rates were similar, coastal FLSs had significantly lower rates of parenteral anti-resorptive therapy recommended ( p < 0.001). Conclusion We have demonstrated a coastal deleterious effect on the quality of secondary fracture prevention of FLS providers as measured by missed opportunities for treatment, vertebral fracture identification and recommendation of parenteral anti-resorptive therapies. Coastal health priority plans in the NHS should prioritise effective FLS provision.