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Introducing mobile fracture prevention services with DXA in Northern Scotland: a comparative study of three rural communities.

Hollick, R.J.; McKee, L.; Shim, J.; Ramsay, N.; Gerring, S.; Reid, D.M.; Black, A.J.


R.J. Hollick

L. McKee

N. Ramsay

S. Gerring

D.M. Reid

A.J. Black


Summary: Mobile fracture prevention services, with DXA, significantly improved access to care for those at high risk of fracture living in rural areas. Introduction of mobile services facilitated access to fracture liaison services and development of integrated of care pathways across community- and secondary-based care. Introduction: The ageing population is growing faster in rural areas, yet most fracture prevention services are located in urban areas. As part of a wider study, evaluating the introduction of mobile fracture prevention services, we focus on whether mobile services improve access to care for those at highest risk of fracture. Methods: Services outcomes were assessed against the Royal Osteoporosis Society clinical standards for fracture liaison services. This included standardised, age-specific referral rates, FRAX 10-year probability of major osteoporotic and hip fracture of referrals, pre- and post-introduction of the mobile service across two island and one rural mainland sites. This was compared with referrals from a similar rural mainland region with local access to a comprehensive service. Results: Greatest impact occurred in areas with most limited service provision at baseline. Mean age of patients referred increased from 59 to 68years (CI 6.8–10.1, p < 0.001). Referral rates increased from 2.8 to 5.4 per 1000 population between 2011 and 2018, with a 5-fold rise in those ≥ 75years (0.4 to 2.0 per 1000). Mean FRAX 10-year risk of major osteoporotic fracture increased from 12.7 to 17.7% (CI 3.2–5.7, p < 0.001). Mean hip fracture risk probability increased from 3.0 to 5.7% (CI 2.0–3.4, p < 0.001). However, referral rates from the mobile sites remained lower than the comparator site. Conclusions: Mobile fracture prevention services, including DXA, greatly improved uptake amongst high-risk individuals. Mobile services facilitated development of integrated of care pathways, including fracture liaison services, across community- and secondary-based care.


HOLLICK, R.J., MCKEE, L., SHIM, J., RAMSAY, N., GERRING, S., REID, D.M. and BLACK, A.J. 2020. Introducing mobile fracture prevention services with DXA in northern Scotland: a comparative study of three rural communities. Osteoporosis international [online], 31(7), pages 1305-1314. Available from:

Journal Article Type Article
Acceptance Date Jan 23, 2020
Online Publication Date Feb 21, 2020
Publication Date Jul 31, 2020
Deposit Date Feb 28, 2022
Publicly Available Date Feb 28, 2022
Journal Osteoporosis International
Print ISSN 0937-941X
Electronic ISSN 1433-2965
Publisher Springer
Peer Reviewed Peer Reviewed
Volume 31
Issue 7
Pages 1305-1314
Keywords DXA scanning; Fracture liaison services; Geographical access; Mobile services; Osteoporosis
Public URL


HOLLICK 2020 Introduction mobile fracture (AAM) (505 Kb)

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