Health: Osteoporosis and Fractures

Lord Bilimoria Excerpts

Thursday 14th September 2023 Grand Committee

[Lord Bilimoria (CB)]

My Lords, my 87 year-old mother Yasmin lives in Dehradun in north India, in the foothills of the Himalayas. She has had severe osteoporosis and osteoarthritis—a point that has not been made is that many sufferers of osteoporosis also suffer from osteoarthritis. In India, of the hundreds of millions of Indians over the age of 50, it is estimated that at least 20% are women with osteoporosis, so it is a major public health problem with Indian women.

As the noble Baroness, Lady Bloomfield, has said, osteoporosis-related fractures are associated with substantial pain and suffering. My mother, fortunately, was diagnosed very early. The gold-standard diagnosis is the dual-energy x-ray absorptiometry DXA. However, very few of these machines are found in India.

This is a global phenomenon: 54 million people in the United States have osteoporosis; women are four times more likely to develop it than men; in Italy, its expense is €10 billion, and in Spain the burden of fragility fractures was estimated at €3 billion; in the Netherlands, the burden of fractures will increase by 30% to over €1 billion.

I thank the noble Lord, Lord Black, for initiating this debate. As he noted, the condition is asymptomatic until fragility fractures take place. It is estimated that there are around 180,000 fractures presenting each year as a result of osteoporosis. This is a huge number. There are GPs who spot it, and, of course, fracture liaison services. I was shocked to discover that only 63 out of 123 NHS trusts—just over 50%—were able to confirm that they have an FLS, whereas 100% in Scotland and Northern Ireland do. Could the Minister confirm why 100% of NHS trusts do not have these FLS services?

There seems to be a lack of the DXA scanners, which I mentioned earlier. From May 2023, 66,469 patients were waiting for these scans, which is 11.2% more than in May 2022. Why can we not have more of these scanners available throughout? Why can there not be a public health campaign about bone health—far more than is taking place now—to make people aware of it? The noble Baroness, Lady Finlay, made the very important point that there should be much more awareness and encouragement of physical activity and access to physiotherapy. I have seen this first-hand with my mother, who suffers so much pain that she has access to physiotherapy. Do we give enough access to physiotherapy? The conclusion is that detection and prevention have to be the way ahead.