Better Bones Campaign – calling for 100% FLS coverage in England and Wales

Craig Jones, ROS Chief Executive - Better Bones Campaign – calling for 100% FLS coverage in England and Wales

The Royal Osteoporosis Society’s (ROS) Better Bones campaign for 100% Fracture Liaison Service (FLS) coverage made great progress in 2023, gaining support from 250 Parliamentarians, 43 charities, seven royal medical colleges and trade unions alike. The unique campaign channels the power of public outreach through articles in the Sunday Express urging the public to write to their MPs, and harnessing support from a growing network of loyal and impassioned supporters.

The Better Bones campaign calls for:

  • A mandate from Government that everyone over 50 should be covered by a quality FLS
  • £30m per year additional investment in FLS to fill the gaps in population coverage and quality
  • A national Clinical Director to lead the change

In England and Wales, currently only half (51%) of NHS trusts have a FLS, the gold standard for systematically identifying, accessing, and treating anyone who breaks a bone after age 50. This means 90,000 people are missing out on vital osteoporosis treatment and at risk of further fractures simply because of their postcode. Achieving 100% access to FLS in England, meaning equal access to vital osteoporosis treatment and care, would put patients in England in line with Scotland and Northern Ireland which currently have 100% FLS coverage. The Welsh government recently committed to delivering 100% FLS coverage. 

Countries around the world also face the problem of inadequate provision of FLS services...could the ROS campaign be a blueprint for action in other countries? 

For inspiration, read ROS CEO Craig Jones’ piece for the Sunday Express last year: 

Light the spark, so things can change

Sometimes politicians ask me ‘If Fracture Liaison Services (FLS) are such a no-brainer, why aren’t more NHS Trusts commissioning them?’

It’s all about awareness, both amongst doctors and the public.  Put simply, osteoporosis is about five years behind the menopause.  Until the high-profile campaign led by Davina McCall, menopause was clouded by silence and stigma.   Now every responsible workplace has a Menopause Policy. For decades, falls and weak bones have misleadingly been seen as ‘just part of getting older’, rather than a medical issue.  The silhouette of the hunched older woman on the road-signs says it all.  It wasn’t the passing of the years that curved her back, but the fractures in her spine.  Early diagnosis and medication can prevent them. 
These ageist, sexist stereotypes have stopped us seeing osteoporosis for the treatable condition it is.  For decades, a culture of passivity and defeatism stopped people taking control.  Low public awareness has meant most people have little to no expectation of their GPs and other services.  Few people know what good treatment looks like, so few people get it.

Bone health and osteoporosis hardly feature on doctors’ training curricula.  No branch of the medical profession owns it, so it falls through the cracks.  That’s why there are so few clinical champions in local communities lobbying Trusts to set up FLS.  Compounding this, NHS England has never asked Trusts to prioritise fracture prevention, so - unsurprisingly - most never have.  That’s why we need a mandate to send a clear message to local commissioners to fund these services.  

At the minimum, someone needs to light the spark.  A transformation fund from Government could be enough to change the picture.  Once FLSs are set-up, Trusts will quickly see the returns, with services breaking even in 18 months and delivering a £3.26 return for every £1 invested.  Beds, ambulances and operating theatres will quickly start seeing the gains.  Given a few years to show what they can do, these services will be there for good.  

The alternative – to do nothing – is the most expensive option of all.  It’ll mean we waste £665m of taxpayers money over the next five years on preventable fractures.  The NHS can’t afford it.  The economy will be denied the skills of the 67,000 older workers with fractures, a third of whom will quit work.  And 8,000 people will die of hip fractures who could have lived. 

A few lines in the Government’s Major Conditions Strategy, without funding, will mean nothing will change.  We’ll be back here in the same place, with the missed opportunities mounting up.  Meanwhile, our ageing population will mean the costs to the taxpayer will spiral. 

Give the overlooked 90,000 people the life-saving medication they desperately need. Light the spark, so things can change. 

Find out more about the campaign at