Chamber and committees

A number of areaswithin the Scottish Government Health Directorates contribute to thedevelopment of policy on osteoporosis.

ScottishIntercollegiate Guidelines Network (SIGN) Guideline 71 on osteoporosis sets outthe evidence for the optimal management of those with osteoporosis. We expectNHS boards to implement that, and other relevant guidelines, locally.

The ScottishEnhanced Services programme for primary and community care circular (PCA (M)(2007)10) has a service specification for falls and bone health. NHS boards canelect to choose this area and there are additional resources to implement theactivities. We have also encouraged boards to think about an initiative dealingwith early intervention.

We have drawn boards’attention to the findings of an NHS Quality Improvement Scotland audit (2005)showing the benefits in preventing future osteoporotic fractures of directaccess to DEXA scanning by patients who have sustained a fracture. We alsocontinue to encourage NHS boards to provide DEXA scanners, in line with SIGNGuideline 71. There is also a national DEXA scanning facility at the GoldenJubilee hospital.

In February 2007we issued HDL(2007)13, which indicates that every NHS board should have a fallsand fracture prevention strategy, with each CHP appointing a falls preventionand management lead to work alongside the rehabilitation co-ordinator whicheach board is expected to appoint to take forward the national rehabilitation strategy.

NHS QualityImprovement Scotland will consider the multiple technology appraisal by theNational Institute for health and Clinical Excellence (NICE) of drugs for theprimary prevention of osteoporosis in post-menopausal women. NHS boards areexpected to take account of NICE appraisals in their planning, funding and provisionof services, to ensure that recommended drugs or treatments are made availableto meet clinical need.

The information requestedis not available centrally.

Specific coding whichpermits the identification of bone density scans has only recently been introduced.Therefore, it is not currently possible to provide a waiting times analysis, however,it will be available in the future.

The information requestedis not held centrally. Data on the observed incidence of admissions to acute hospitalswith a diagnosis of osteoporosis from 1999-2006 inclusive, broken down by genderand NHS board area, is available in the answer to question S3W-5087 on 30 October 2007.All answers to writtenparliamentary questions are available on the Parliament’s website, the search facilityfor which can be found at http://www.scottish.parliament.uk/webapp/wa.search.

We are aware of concernsabout the need for younger (i.e. under 70) women to have access to treatment whentheir risk of fracture is equal to, or greater than, that of women aged over 70.The information to NHS boards from SIGN Guideline 71 is to target osteoporosis assessmentat those with the highest risk, to ensure the most efficient use of resources. Theneed for younger women to be assessed when they have low bone mineral density isrecognised by the National Institute for health and Clinical Excellence (NICE) report.When the final report is released, NHS Quality Improvement Scotland will give adviceto NHSScotland on the recommendations from NICE on primary prevention of osteoporoticfragility.

The information requestedis given in table numbers 1 and 2, which show the number of hospital admissions for Osteoporosisand Hip Fracture for each NHS board of treatment for financial years 1999 to 2006, copies of which are available in the Scottish Parliament Information Centre (Bib. numbers 43896 and 43897 respectively).

This information isnot available centrally in the form requested. SMR01 data provides an estimate of the number of people diagnosed with osteoporosis in a given year, and this is setout in the following table.

Incidence¹of Hospital Admissions with any Diagnosis of Osteoporosis²

Financial YearsEnding 31 March

	1999	2000	2001	2002	2003	2004	2005	2006
Scotland3
Both sexes	3,387	3,304	2,841	3,025	3,456	3,687	4,350	4,308
Males	539	536	433	492	563	591	647	709
Females	2,848	2,768	2,408	2,533	2,893	3,096	3,703	3,599
Ayrshire and Arran
Both sexes	267	261	196	321	352	420	451	387
Males	32	45	38	46	61	71	67	47
Females	235	216	158	275	291	349	384	340
Borders
Both sexes	80	86	85	62	66	79	90	78
Males	21	15	13	12	15	21	13	14
Females	59	71	72	50	51	58	77	64
Argyll and Clyde
Both sexes	276	237	206	179	232	245	247	196
Males	42	44	30	29	44	41	42	26
Females	234	193	176	150	188	204	205	170
Fife
Both sexes	160	257	239	296	263	269	359	328
Males	25	35	25	39	46	37	50	60
Females	135	222	214	257	217	232	309	268
Greater Glasgow
Both sexes	814	717	682	657	767	796	1,093	1,067
Males	130	110	106	103	116	136	184	200
Females	684	607	576	554	651	660	909	867
Highland
Both sexes	102	120	76	134	223	205	217	256
Males	13	20	7	20	38	22	18	42
Females	89	100	69	114	185	183	199	214
Lanarkshire
Both sexes	264	228	187	172	203	181	258	243
Males	52	39	29	29	31	30	37	46
Females	212	189	158	143	172	151	221	197
Grampian
Both sexes	266	297	227	260	334	431	420	529
Males	41	49	32	45	52	54	51	70
Females	225	248	195	215	282	377	369	459
Orkney
Both sexes	5	9	11	8	12	18	16	14
Males	0	1	0	0	4	3	1	1
Females	5	8	11	8	8	15	15	13
Lothian
Both sexes	565	543	463	487	507	521	625	672
Males	82	103	85	90	90	94	88	114
Females	483	440	378	397	417	427	537	558
Tayside
Both sexes	194	181	165	156	171	213	269	247
Males	26	23	27	31	22	24	47	38
Females	168	158	138	125	149	189	222	209
Forth Valley
Both sexes	186	172	137	95	127	119	107	85
Males	41	26	16	19	17	27	15	18
Females	145	146	121	76	110	92	92	67
Western Isles
Both sexes	31	21	18	27	42	11	13	19
Males	6	2	6	7	7	2	3	3
Females	25	19	12	20	35	9	10	16
Dumfries and Galloway
Both sexes	175	169	142	163	154	168	177	162
Males	27	23	18	19	20	28	29	23
Females	148	146	124	144	134	140	148	139
Shetland
Both sexes	2	6	7	8	3	11	8	25
Males	1	1	1	3	0	1	2	7
Females	1	5	6	5	3	10	6	18

Source:SMR01.

Notes:

1. Incidence isdefined as a patient’s first ever discharge with the specified diagnosisscreened backwards through the patient’s discharge history for 10 years (1997).

2. Up to sixdiagnoses (one principal and up to five secondary) are recorded on SMR01. All sixdiagnoses have been used to identify osteoporosis employing the

 InternationalClassification of Diseases, 10th revision (ICD10) codes M80-M82.

3. Excludesresidents out with Scotland, of no fixed abode or unknown.

The information requestedis not available centrally.

Specific coding whichpermits the identification of bone density scans has only recently been introduced.Therefore, it is not currently possible to provide a waiting times analysis, howeverit will be available in the future.

Health departmentletter HDL (2007) 13 asks all health boards to take the lead in developing a combinedfalls prevention and bone health strategy by the end of  2007-08, under which CommunityHealth Partnerships can establish operational implementation strategies to be ledby a falls prevention lead or co-ordinator. The letter acknowledged that actualtimescales would depend on current falls prevention activity within each area. the Scottish Government will monitor progress towards the end of 2007-08.

No financial estimateshave been made for the costs of preparing falls prevention strategies or appointingfalls prevention leads or co-ordinators. This is a matter for local healthboards and Community Health Partnerships. A reduction in preventable falls shouldprovide cost savings for health services.

I refer the memberto the answer to question S3W-5095 on 29 October 2007. Allanswers to written parliamentary questions are available on the Parliament’s website,the search facility for which can be found at http://www.scottish.parliament.uk/webapp/wa.search.