Plenary, 05 Dec 2002

Meeting date: Thursday, December 5, 2002

Official Report 682KB pdf

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Osteoporosis

The final item of business is a members' business debate on motion S1M-3508, in the name of Fergus Ewing, on osteoporosis. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes that osteoporosis is a major public health problem which results in more than 20,000 fractures a year in Scotland, that the cost of osteoporotic fractures in the United Kingdom each year is estimated at over £1.7 billion and that one third of women and one in 12 men over 50 will suffer an osteoporotic fracture; further notes that with an ageing population profile this problem will become even more serious; is aware that osteoporosis is both treatable and largely preventable; welcomes the fact that the public and health professionals are becoming increasingly aware of osteoporosis as a major health problem but is concerned that health service provision throughout Scotland is patchy and that access to diagnostic testing and monitoring varies around the country; believes that sufficient funding can be made available so that all patients have equal access to services for both the diagnosis and treatment of osteoporosis and that all patients suffering a fragility fracture or having other risk factors for the disease should be assessed for the presence of osteoporosis, and further believes that public health campaigns should be promoting the importance of lifestyle factors as influencing bone health and preventing osteoporosis.

I am grateful to the Parliamentary Bureau for the opportunity to debate the issue of osteoporosis for the first time in the Scottish Parliament. Osteoporosis is one of the most widespread and pernicious diseases and affects more people than virtually any other serious disease or condition that we know of.

Osteoporosis, which is also known as fragile bones disease, affects men and women. One in three women and one in 12 men over the age of 50 will suffer from an osteoporotic fracture. The disease is a major cause of pain and disability and, in extreme cases, can cause death. The most common fractures that result from osteoporosis are fractures of the wrist, spine and hip. As the population of Scotland is ageing, the number of people who suffer from osteoporosis will continue to rise and the number of people who are at risk of fractures that are caused by osteoporosis is set to rise.

There is a huge financial cost in social care and in the acute costs of treating osteoporotic fractures. That cost is estimated at £1,700 million a year in the UK and £150 million in Scotland. There are huge costs to the national health service and social services. More than one fifth of all orthopaedic beds are used by patients who have had hip fractures. The acute care cost for each hip fracture patient is around £5,000, and there are approximately 6,000 hip fractures each year in Scotland. More than half of patients who have a hip fracture are unable to live on their own or to sustain independent living as a result. That of course means that some may require residential or other care, which imposes a huge cost.

Behind those dry statistics, chilling though they are, lies the real issue that I want to talk about, which is the human cost—the hundreds of thousands of tales of misery and pain of the people who have the disease. The pain that is suffered, patients' great anxieties about what the future holds and the misery that the disease can create should not be under-estimated.

It is essential that we have a better understanding of the disease in Scotland. I pay tribute to the work of the National Osteoporosis Society, which is represented in the gallery, and in particular to Anne Simpson, who is well known to many of us as she has made us more aware of the problems of osteoporosis.

The NOS, which operates throughout Scotland and the UK, holds open meetings to spread awareness of osteoporosis and does a great deal of excellent work in the general promotion of good bone health. Fifteen local support groups have been established in Scotland and play a huge part in passing on information and supporting sufferers, often on a one-to-one basis; I saw that at first hand when I recently attended the annual general meeting of the Inverness osteoporosis support group. The groups provide succour to families and are a series of excellent ginger groups, the members of which—perhaps from their own or their family's experience—are well able to put pressure on local health boards and professional staff to improve services in their area.

What would each of us do if we were told tomorrow that we had osteoporosis? What would be in our thoughts? Who would we turn to? How would we look towards the future? Perhaps we would be extremely anxious. We would not know what the future would hold, how serious the condition would become and how quickly symptoms would develop. We would ask obvious questions such as, will the treatment work? Can I play golf? Can I bowl? Can I do the garden? If I do those things, will I risk breaking a bone?

The NOS, drawing on the experience of members of the support groups, has produced an excellent strategy document called "Reducing fractures and osteoporosis in Scotland: A strategy for Health Boards, Local Health Care Co-operatives, Acute and Primary Care Trusts".

Where do we go from here and what needs to be done? Four issues need to be addressed. The first of those is a positive move—the impending introduction of the new Scottish intercollegiate guidelines network, or SIGN, guidelines, which will be published in spring 2003. Those guidelines will set out best practice for general practitioners and other health professionals and hospital clinicians on the way in which osteoporosis is diagnosed and treated and how patients who are most at risk can be identified. Obviously, those who are most at risk include women with early menopause, those who take steroids and those who have a poor diet. The publication of the guidelines will raise awareness among professionals of best practice. The NOS has ensured that the guidelines fully reflect the patient's perspective. I urge the minister to ensure that the guidelines are implemented throughout Scotland. When the minister responds to the debate, I ask him, first, to indicate whether that will happen.

Secondly, although the disease does not have a cure, it can be prevented and treated. To do that we should adopt a cradle-to-grave approach. We must target young people with the message of healthy bones. Surveys indicate that youngsters are not taking to heart any of the messages, which are extremely important. Free school milk for kids may seem like a costly policy, but in the long term it would provide a massive saving in human and financial terms. We must persuade kids that milk is not only good, it is cool, it tastes good, it makes them feel good, and it might even make them look good.

Thirdly, it is essential that dual-energy X-ray absorptiometry—DEXA—scanners are made more widely available in Scotland. Much work has been done, notably in the Highlands, where a DEXA scanner was obtained largely as a result of the work of Lorna Young, who has harried, badgered and lobbied on that issue for years. However, many people in Scotland do not have access to a DEXA scanner, which is a fatal defect.

Fourthly, we must educate health professionals. I acknowledge that the Health Education Board for Scotland and the health department have done a lot of work, but much more needs to be done.

The Presiding Officer is giving me that certain look, so I will draw my remarks to a close. I look forward to other members' speeches. I am proud that we are having the debate. I hope that the minister will tell us whether a strategy will be prepared for Scotland and to what extent health boards will be invited to implement the guidelines and ensure that DEXA scanners are available to everyone. We have an opportunity to explode the myth that nothing can be done about osteoporosis, which is the exact opposite of the truth. I hope that the debate will play a part in showing that there is a will across all the political parties to find the way ahead.

I will not be able to stay until the end of the debate because I hope to catch the early evening train to Inverness, so I apologise to the Presiding Officer and to members.

I thank Fergus Ewing for securing the debate. When I attended the presentation that the National Osteoporosis Society gave a couple of weeks ago, I knew nothing about osteoporosis, except that it made people's bones crumble, that old folks got it and that not very much could be done about it. How wrong I was. I am grateful to the society and the members of the area groups who came to Edinburgh to speak to us about the condition. I now have an understanding—albeit a basic one—of a condition that is debilitating for many people, but which is preventable and treatable. However, treatment and diagnosis are not available throughout the country. As Fergus Ewing said, we are lucky in the Highlands because there is a DEXA scanner in Dingwall, but not every part of the country is so lucky.

Awareness of the condition is important. We must educate people to protect their bones. Fergus Ewing's point about diet is crucial. It is a sad fact that even if one puts milk in front of children nowadays, some will not drink it because they want a fizzy drink instead. We must take account of the fact that people's unhealthy eating habits will prove disastrous in the future.

It would be expensive to install DEXA scanners throughout the country, but they would save the great deal of money that the national health service spends on people who have a grave form of osteoporosis. We must also take into account the misery and uncertainty of people who suffer from osteoporosis and the uncertainty of their families. I now realise that osteoporosis is not something that only elderly people have and that people who are much younger can get the condition.

It is important that there is proper diagnosis and treatment for osteoporosis and education from an early age to try to get children to drink milk and to take exercise, for example by walking to school. I ask the minister to consider the matter as a whole and to find out whether by spending a comparatively small amount of money now we could save a lot of money in the future and help people who otherwise would have miserable lives.

I congratulate my colleague Fergus Ewing on securing the debate. I know that this is a subject in which he has been interested for some time. He has pursued it diligently by the various parliamentary routes, which have culminated in today's debate.

Fergus Ewing has presented the facts of osteoporosis in our society. One in three women and one in 12 men can expect to suffer from osteoporosis. The commonly held view is that osteoporosis is an illness of the old. However, the National Osteoporosis Society's booklet tells the story of Anna Richmond, a 15-year-old girl who suffered from anorexia. After a four-year battle with that condition, she found herself suffering from osteoporosis. She had lost some 2in in height before she had even reached the age of 20. That illustrates the fact that young people can also suffer from this condition, which can be very debilitating for them. For Anna, things got better following effective treatment and she has gone on to become a doctor. She now works closely with the National Osteoporosis Society, which shows that, with effective treatment, people who suffer from the condition can lead an almost normal life.

Fergus Ewing said that the condition cannot be cured, but it can be prevented. It can also be treated, but I shall focus on prevention. We should, where possible, ensure that future generations are taught about the potential dangers of osteoporosis if they fail to have a suitable diet and to take adequate exercise. I agree with the arguments for providing free milk in schools. I always enjoyed my free milk when I was at school. Winnie Ewing has also pointed out to me that fish is very good for the bones. However, I do not want to encroach on that territory in case Stewart Stevenson intends to cover it later in the debate. It is important that young people have the opportunity to have a healthy diet to head off the potential development of osteoporosis in later life.

Sport also plays an important role in ensuring that young people develop healthy bones through regular physical exercise. We know from the statistics that fewer of our young people—especially young women—are participating in sporting activities. We are already seeing the warning signs of that in increasing levels of juvenile diabetes and obesity among young people. If we do not ensure that young people have a healthy diet and participate more in physical activities, the possibility of their developing osteoporosis in later life will be much greater.

Fergus Ewing mentioned the potential impact on our health service. It is essential that the services that are available for those who suffer from osteoporosis are the best that they can receive. Those people should have ready access to the necessary medical treatment and the diagnostic procedures that they have to undergo if they are considered to be possibly suffering from the condition. Alongside that, there must be regular monitoring of those who have been diagnosed as having osteoporosis, where possible, to ensure that their condition is being kept in check. The only way to achieve that is for GPs to be aware of the condition, and the SIGN guidelines will help to address that. We must also ensure that the acute hospitals sector has the resources to provide the continuing monitoring that is required.

I hope that, in his closing remarks, the minister will be able to take a broader approach to the issue, rather than a purely medical approach, and address ways in which we can improve the health of our young people to head off the problem in the future.

I thank Fergus Ewing for giving me the opportunity to speak on this subject. Fergus raises this issue persistently every time that MSPs from different parties meet the health chiefs in the Highlands. He does not always get the answers that he wants, but that does not stop him from raising the issue of osteoporosis as regular as clockwork.

I, too, would like to commend the National Osteoporosis Society on its strategy document "Reducing fractures and osteoporosis in Scotland: A strategy for Health Boards, Local Health Care Co-operatives, Acute and Primary Care Trusts", which was published in November 2000. I was heartened by the comment on the inside page from the chief medical officer for Scotland, who states:

"I hope that Local Health Care Co-operatives and Health Boards, Primary Care and Acute Trusts make its implementation a priority as part of their work in reducing osteoporotic fractures."

The strategy is also commendable because it is based on the principles of prevention and investment to save costs in the long run. Too often, we only consider issues such as how to cure fractures, but if we spent more money on prevention—which is at the heart of Fergus Ewing's motion—we would save money in the long run. The £150 million cost of osteoporosis to the NHS in Scotland cannot possibly measure an individual's loss of independence or the impact of bedblocking—or delayed discharge, as we call it. The most recent figure for that was 2,920 in July 2002, which represents a spending of millions of pounds.

Given that osteoporosis is treatable and preventable, any investment will undoubtedly save the NHS millions in the long run. I was shocked when I read the figures to find that only 50 per cent of osteoporosis patients return to full, independent living. The 50 per cent who do not do so represent an enormous amount of patients.

The SIGN guidelines are due in spring 2003 and will be welcome. I hope that they will be based on the NOS's strategy. All SIGN guidelines are welcome, but only if they are adhered to. If they gather dust on a shelf, they are of no great benefit. However, I am pleased to see that pharmacists are included as one of the agencies in the NOS's strategy. The strategy document states that pharmacists should

"encourage adherence to pharmacological treatment"

and

"ensure patients understand their medication and adhere to dosage."

I raise that matter in relation to a fact about which I got confused, which is that calcium is recommended to reduce vertebral fracture risk, but only if it is combined with vitamin D.

When one gets to a certain age in life and is considering how to avoid osteoporosis, one might read the following statement from the NOS's booklet: "Osteoporosis: Causes, prevention and treatment":

"There are some risks associated with HRT,"—

which is of course a common means of preventing and treating osteoporosis—

"such as a slight increase in both the risk of breast cancer (after five years of HRT use) and the risk of a blood clot (deep vein thrombosis)."

That is a wee bit confusing. I welcome the fact that pharmacists are included in the NOS's strategy. One might consider hormone replacement therapy as a means of preventing osteoporosis, but that would have to be measured against the risks that the booklet outlines.

As Michael Matheson said, much more can be achieved by health professionals working together to address osteoporosis. I also hope that the SIGN guidelines will give clear, unambiguous guidance because I found that the guidance is certainly not crystal clear. I am grateful for the opportunity to speak in the debate. I hope that the underlying principle of prevention will be adhered to for osteoporosis and many other conditions.

I am happy to come along and support Fergus Ewing's motion and to take part in what I expect to be a consensual debate. I think that some of us at least will be old enough to remember children with rickets and the large number of older ladies in particular who were stooped and crippled in old age because of undetected and untreated fractures, among other causes.

I mention rickets in particular because it has all but been eliminated in our young. However, there is some re-emergence of it because of dietary problems that are not the result of a lack of money, but of the spending of it in the wrong way on the wrong diet.

I well remember, in the immediate post-war period, going to the Ministry of Health office to collect my orange juice and cod-liver oil. As Michael Matheson would doubtless want me to acknowledge, fish is extremely important and as Fergus Ewing would doubtless want me to want me to clarify, yes, I am that old.

Diet is important. I grew up in an area with calcium-rich water and, until I left home, I did not realise that soap was supposed to foam. All that happened when I used it was that it formed a scum around the bath, and that was due not simply to the infrequency with which my parents persuaded me that I should bathe, but to the high amount of calcium in the water, which was absorbed into my teeth and bones. Not everyone is so lucky, of course. In the west of Scotland, where the water is much softer, the opportunity to take up calcium is much reduced.

Some estimates suggest that 50 per cent of young women take up inadequate calcium in their diet and, while there is a suggestion that young men do little better, they are not exposed to the risks later in life that can lead to bone mass depletion, such as pregnancy, breast feeding and blood loss. Women have particular problems, which is why one in three of them will experience osteoporosis at some stage in their lives.

Young women and men are taking less exercise than they used to and exercise is important in building up bone mass at an early age. That is helpful because it means that any later loss of bone mass is offset against the substantial amount that was present in the first place.

Of course, there are other risks. A substantially higher number of young people than ever before suffer from asthma. When I was a bairn, I was one of only three who suffered from asthma in my year. Now, however, the proportion would be substantially higher. Much of the treatment of asthma is done through the inhalation of steroids, which are another cause of bone mass depletion, which means that, in the future, there might be an uplift in problems relating to bone mass depletion.

Furthermore, the inadequate calcium intake that I spoke of earlier means that people's teeth are not as good as they used to be. One of the results of that is gingivitis and inflammation of the gums. Again, the treatment for those problems is generally steroid-based.

I am sure that we all agree about the need to address the range of problems that are developing in our young people with regard to osteoporosis. However, I should also mention that there is a rise in the number of auto-immune diseases of one sort or another, which affect all age groups and which are also often treated with steroids.

Just as we eliminated rickets in the young by appropriate action after the war, it is important that we eliminate osteoporosis in the old now. It has been suggested that exposing people to sunlight for 15 minutes on three occasions a week would be a help. I do not propose that the Executive send everyone to the south of Spain three times a week; an improvement in the weather in Scotland would be welcome, however.

Let us bear it in mind that the cost of treating the fractures that are caused by osteoporosis is £15 a year for everyone in our population. This is an important problem. We must spend more money but we must also devote more of our attention to the problem.

About this time last year, my husband and I were in our sitting room when we heard an awful thud from upstairs, where our nonagenarian aunt was going to bed. We found her lying on the floor and it transpired that either she had fallen and broken her leg or she had fallen because her leg had broken. Whichever is the case, she spent weeks in hospital and, while she has made an amazing recovery, she is markedly more frail than she was before. Often, elderly women who are leading independent lives prior to a similar incident are not able to go back to independent living afterwards and need expensive service provision. No one would grudge them that, but everyone involved would prefer to avoid it if at all possible. It makes both humane and material sense to take osteoporosis seriously.

It is important to make people aware of the lifestyle choices that can help to prevent osteoporosis and I would endorse what Fergus Ewing said about that and emphasise that exercise is important in early life.

Osteoporosis occurs in men, but women are much more at risk, as they have naturally smaller bones, which are less dense, and also because the menopause greatly accelerates bone loss.

Osteoporosis is called the silent disease, because bone loss occurs without symptoms. Awareness of risk factors is therefore important. The diagnostic test for osteoporosis is a bone density scan. I advocate better access to bone density scanning for women who may be at risk because it is a good thing to do, but also because it is spending to save. Screening can reduce the incidence of fractures by half.

I will mention some of the work that has been going on in Aberdeen over the past 10 years. In 1994, I was one of a random sample of around 5,000 women in Grampian who were called in for bone density scans. In passing, it was comforting to discover that my bones were suitably dense, but of wider benefit than my peace of mind was the useful data that were collected to inform policy on osteoporosis.

In Grampian, general practitioners and hospital doctors can refer patients at risk of osteoporosis for bone density scans, but there is a waiting list of about a year. The scanning facility costs about £55,000 per annum, excluding the consultant's time, and processes 1,500 scans every year. Dr Reid, who runs the service, estimates that 2,500 scans per annum would meet the demand. At a cost of £36 per patient, that could prove to be a good investment.

Almost 10 years ago to the day, I broke my wrist on the morning of the 12/12/92 demonstration for democracy as part of the campaign to achieve the Parliament. I know from that experience how debilitating three months in plaster was—I could not wash my hair or get the Christmas presents, for example. As Mary Scanlon said, for those who suffer from osteoporosis and cannot necessarily return to active living, it is imperative that we address the issue. We must have sympathy with osteoporosis suffers, but if one message is coming from the debate, it is that prevention and considering osteoporosis in the round for all the community are the way forward.

I am particularly interested in the material on the action plan for population-wide primary prevention measures, with which the National Osteoporosis Society provided us. That material shows us the areas for intervention. Half the problem is that people are not aware that they might be at risk. Those with a family member—perhaps a mother—who has had, for example, a hip problem, might be worried that they or other female family members have osteoporosis, but not know what to do or where to go. When they decide that they want to do something about it, the facilities might not exist for them to have the scan that can help so much.

From contacts that I have had with the National Osteoporosis Society, I know that there are problems in Edinburgh, where no clinician specialises in osteoporosis. In the Forth Valley NHS Board area, there is no clinician for osteoporosis. We must address those issues and ensure that, where we can get the prevention message across, we have the facilities to follow it through. I also have concerns about the availability of scanners. My understanding is that there is none in the Forth Valley area. The scanner at St John's hospital at Howden in West Lothian is open only on a Monday and a Wednesday. In Edinburgh, there is only one scanner, at the Western general hospital.

I appeal to the minister to think about osteoporosis in the round and to think about it in the public health arena, particularly among our young people. There is a danger that osteoporosis is considered to be something that affects older people. We can change the agenda by recognising, as Michael Matheson did, that we need to think about younger people not only as sufferers, but in terms of prevention. My children get their milk and enjoy it. However, an awful lot can be done, particularly on the nutritious school meals agenda. Are we taking the calcium agenda into the nutritious school meals agenda?

I understand that the minister was at last week's falls prevention conference, which was held in conjunction with Age Concern Scotland and health professionals. The National Osteoporosis Society is concerned that osteoporosis is only considered part of the older age group agenda. Will the minister reassure us that, when he considers what the Executive can do to support the osteoporosis agenda, he will acknowledge that it must be part of the public health agenda?

As I have said, we should address the issue in the round. Let us ensure that we make a difference, because investment made today will reap rewards for tomorrow. If that means peace of mind for today's population and security for the next generation, we should make that investment.

I thank Fergus Ewing for raising the important issue of osteoporosis, which affects a considerable number of citizens in Scotland. I also thank the National Osteoporosis Society for maintaining a public profile on the issue. There is a consensus in the chamber and among political parties about the variety of strategies that need to be adopted to tackle what is a growing concern.

I wish to address the demography of osteoporosis, its age profile, the approaches that may be taken at health board level and the question of resources, as well as other points that members raised in the debate.

I have listened carefully to what we might call the personal confessions from individuals' pasts. I remind Stewart Stevenson of the old Jesuit phrase: "I cannot know what you know." Now that I know what his bathing quality was like, I might keep 10 or 15 yards away from him in future.

On Michael Matheson's contribution, I recall the discussion that we shared on a previous occasion. I will make a confession—and this will be a big surprise to everyone. Sadly, I was a milk monitor. Members can imagine the kind of scams that were pulled to maximise the consumption of milk by Michael and friends over the week. I made him particularly sick of it, judging from what he had left in the stash by the end of the day.

Of course, osteoporosis is an important issue, and members have quite rightly identified the figures. The evidence suggests that, typically, about one in three women and one in 12 men over the age of 50 will have an osteoporotic fracture at some stage in their life. The condition has a clear impact.

Clearly, there is an exceptional cost element for the health service, but the real issue is how we change the dynamic, so that we avoid having to administer costly treatment and so that we find various ways to make a difference, through lifestyle and support services.

Members have mentioned the risk factors that are associated with a family history of osteoporosis, particularly among women. The incidence of smoking among women has increased over the past 20 years, and we must bear in mind a range of other issues related to lifestyle choice, opportunities for exercise and so on.

Mary Scanlon touched on the impact of hormone replacement therapy on women who are going through, or are just past, the menopause—we have to consider the fact that pills, implants and gels that are used to replace oestrogen in the body do not have the same effects. We need to address the range of issues and co-ordinate our actions.

Not that long ago, the National Osteoporosis Society produced a document with a foreword by Dr Mac Armstrong, the chief medical officer, which contained a series of strategies.

One of the key themes of the debate was what the Executive is trying to do and what the Executive can encourage people to do to make a difference. I note that my colleague, Andy Kerr, the Minister for Finance and Public Services, is here. One of the key elements in the latest spending review was the health improvement agenda. In the long run, that should start to intervene in the areas that members have highlighted, if things are done properly over the next few years. That involves trying to reduce the incidence of smoking and recognising the impact of other lifestyle choices.

I recognise the different views about the impact on young children of milk at different stages of development. The use of milk among young primary school children would have a substantial impact; whether or not its use is most effective for teenagers, particularly teenage girls, is openly debated in health circles. We are keen to move on that issue. That is why we want to make progress on the recommendations of the expert panel on school meals, which advised that, each week, children should have at least one portion of food from milk and dairy products in their school meals.

Many local authorities have adopted a positive approach to milk, but that is not universal throughout Scotland. That is one of the issues that ministers are currently having to assess in the context of the health improvement agenda and as a consequence of the Parliament's recent debate on the broader issues around school meals.

I have outlined some of the key strategies. Another key strategy is to keep people physically active. That is especially important for younger people. The physical activity task force, which reported recently, produced a series of recommendations aimed at keeping Scotland's older people physically active. A range of measures is being taken.

We need to reduce smoking and alcohol misuse, to implement the diet action plan and to develop the work of the physical activity task force. Measures that have been taken over the past few years to encourage breast-feeding have had an impact in parts of Scotland. The challenge is to ensure that breast-feeding takes place in all social classes and becomes much more widespread. We also need to make the investment that people have requested in the active primary schools programme and in school sport co-ordinators. In the long term, those measures should make a difference.

We recognise that more immediate action is needed. Both education and intervention are required. I acknowledge the point that was made about the recent falls prevention conference. We need to be concerned about the impact of falls not just on Scotland's older people, but on young people.

I want to stress the issue of research, which was raised in the debate. Substantial research has been undertaken so far. The chief scientist office would welcome well-founded applications for funding for research into osteoporosis. Currently it is funding one research project on osteoporosis, which is entitled "Identification and mapping of osteoporosis genes in the general population by DNA pooling". Once we have that evidence, we may be able to target resources, as Nora Radcliffe suggested.

At the moment, scientists are telling us that the statistical return on the use of scanning machines is uneven. It is difficult to justify a national screening programme, because in 50 out of 100 cases the result may be unclear. The National Osteoporosis Society wants to open up a debate on that issue. I reassure members that the door is not closed on screening, but for the reason that I have given, the Medical Research Council is not convinced that a national screening programme would be effective.

I do not disagree with any of the points that the minister has made. I understand that the NOS is not calling for national screening to be introduced. However, it is very concerned about the availability of scanning, especially for those who are most at risk. The minister and a number of other members have mentioned which categories of people are most at risk. Will he undertake to extract from each health board—particularly those where cover is non-existent or patchy—a statement indicating whether it will adopt a policy on scanning, what access will be available and what policies will be followed? Will the Executive actively pursue the issue of scanning in the future, to ensure that all people who are at risk have proper access to a DEXA scan?

I am conscious of the time, but I will try to deal with the key issues that Fergus Ewing has raised.

The Scottish needs assessment programme produced advice on protection against, detection of and management of the disease, which has been issued to boards to assist them in dealing with the issues. If Fergus Ewing is seeking an overview of the situation, we would be happy to explore that with health boards. Health boards need to carry out a mapping exercise to determine scanning requirements and the number of staff who are needed to deliver the service.

The Scottish intercollegiate guidelines network, to which members have referred, is in the process of producing a clinical guideline on osteoporosis, which is expected to be completed early next year. We want to use that as one way of improving the quality of service throughout Scotland. If we seek quick successes, we must identify where the highest risk factors are concentrated. By pulling together the two or three strategies that I have outlined, we can genuinely make a difference.

The fundamental message that members have conveyed is that we will make a difference in the long term by changing the lifestyle and health environment of citizens in Scotland. We may no longer have to deal with poverty factors such as rickets, but people are making unwise diet choices that will have an impact on our capacity to cope with osteoporosis, which emerges as people become older.

Tonight has been a welcome contribution. I am happy to take on board the specific points that members have raised on follow-through and to come back to members to indicate what we can do. I am also conscious that all MSPs received a booklet from the National Osteoporosis Society this week, which I hope will help to develop ideas. No doubt questions will follow that welcome development.

I thank Fergus Ewing for giving the Scottish Parliament its first opportunity to discuss osteoporosis. I hope that in a few years' time, we can come back and say that a difference has been made in relation to some of the things that came out of the discussion. That is the fundamental reason why we all wanted the Parliament to succeed in the first place.

Meeting closed at 17:50.