Osteoporosis (Hansard, 10 December 2002)

§ Lord Hunt of Kings Heath
My Lords, the National Service Framework for Older People covers falls services, which includes osteoporosis. The national service framework provides a clear basis for delivering improvements in prevention, care, treatment and rehabilitation.

§ Baroness Greengross
My Lords, I thank the Minister for that positive and informative reply. Does he agree that it is important to take a life-course approach towards tackling conditions such as osteoporosis? Despite preconceptions, osteoporosis is neither a condition that is caused by old age nor does it affect only women. As regards the national service framework, is the Minister aware that the National Osteoporosis Society estimates that, despite the NSF, 90 per cent of sufferers receive little or no advice or therapy to help them avoid repeat fractures? Does not this mean that many unnecessary further fracture repairs have to be carried out, at great cost to the NHS and causing great distress to those concerned and to their families?

§ Lord Hunt of Kings Heath
My Lords, I agree that prevention is very important. The National Institute for Clinical Excellence is producing guidelines on osteoporosis which I hope will deal with many of the points raised by the noble Baroness. Prevention of osteoporosis is dependent on establishing a maximum bone mass and density in early adulthood and on minimising bone loss later in life. Avoiding risk factors where possible is important, and our recommendations to the public include our old friends of not smoking, avoiding excess alcohol intake and taking regular exercise throughout one's life.

§ Baroness Gardner of Parkes
My Lords, is the Minister aware that many young people—ballet 102 dancers, athletes and people we would think of as being amazingly fit—can suffer from severe osteoporosis because of a very restricted diet?

§ Lord Hunt of Kings Heath
Yes, my Lords. Although osteoporosis in children is very rare, the noble Baroness is right to point out that it is not confined to older people. That reinforces the point of having good prevention programmes.

§ Lord Clement-Jones
My Lords, is the Minister aware that one of the key problems suffered by those with osteoporosis is the failure to diagnose their fractures at fracture clinics? Would it not be a good scheme to use nurses with appropriate skills so that fractures are diagnosed good and early and further patient suffering is reduced?

§ Lord Hunt of Kings Heath
My Lords, I am always keen to see the role of nurses extended, particularly the role of specialist nurses. The review of clinical guidelines by the National Institute for Clinical Excellence will pick up on those points and on the role of GPs and primary care in this area.

§ Baroness Billingham
My Lords, further to the point about prevention rather than cure, is it correct that regular exercise for all age groups is very important? Are the initiatives being monitored and displayed by the Government and Sport England helpful in this area?

§ Lord Hunt of Kings Heath
Yes, my Lords. I would encourage local initiatives between the National Health Service, local authorities and sports authorities to ensure that more people take up healthy lifestyles. More importantly, young people should be encouraged to take more active roles by walking and cycling to school, and schools should be encouraged to provide more opportunities for physical education.

§ Baroness Masham of Ilton
My Lords, in declaring an interest, how long should people taking HRT to combat osteoporosis stay on it?

§ Lord Hunt of Kings Heath
My Lords, I cannot give a definitive view of the length of time. We know that there are potential risks as well as benefits in the use of hormone replacement therapy. We know that some women cannot tolerate the therapy but, equally, it is an important way of countering and reversing osteoporosis. This is a matter on which clinicians should advise women on an individual basis. We need to recognise that there is a balance between its benefits and the risks involved.

Baroness Sharpies
My Lords, is the Minister aware that in Millbank we are now able to get advice on and an investigation into our health. I was told that one of the most important things is that we should take good exercise to avoid any of these problems in the future?

§ Lord Hunt of Kings Heath
My Lords, I am glad to hear that. I do not know whether my noble friend the 103 Chief Whip will agree, but certainly the more Divisions that are called in your Lordships' House the more we need to run and walk to get here quickly.

§ Baroness Finlay of Llandaff
My Lords, given the Minister's response in regard to the risks of long-term HRT and the risks that are recognised in hysterectomised women on oestrogen-only replacement, with in excess of three ovarian cancers per 1,000 women over 10 years, what are the Government's plans to instigate ovarian cancer screening in this sub-group of the population who are particularly at risk?

§ Lord Hunt of Kings Heath
My Lords, the Government have made clear in relation to screening that we shall be advised by the national screening committee. When the committee reaches a view that screening is appropriate in relation to particular conditions, the Government will consider the matter carefully.

§ Baroness Massey of Darwen
My Lords, screening for bone density is extremely important in preventing the risk of fractures and osteoporosis. I understand that the average wait for screening is about nine weeks and that screening is mainly concerned with patient monitoring rather than with diagnosis. What will be the situation as regards screening in the future?

§ Lord Hunt of Kings Heath
My Lord, clearly, where screening is considered to be effective, we would wish to see programmes put in place to ensure that people have access to screening as soon as is practical. In fact, the expert advice that we have received is that bone scanning is not appropriate for the general population. The UK National Screening Committee considered this matter in June 1999. Its recommendation was that population-based screening should not be offered in general, although bone scanning can be helpful in monitoring treatment in individual cases.

§ Lord Colwyn
My Lords, is the Minister aware that there are many diseases—including osteoporosis, cardio-vascular disease, diabetes and many cancers—that are treatable successfully if diagnosed early enough? Does the Minister foresee a time when any government will have the sense to invest in preventive treatment that does not necessarily show success within a given five-year period?

§ Lord Hunt of Kings Heath
My Lords, a number of actions that the Government have taken have indicated that we do indeed take the view that investment in prevention pays dividends over many years ahead. Indeed, our intention to give resources to the NHS over a longer period of time will help in that process. The work by the National Institute for Clinical Excellence to produce guidelines will give emphasis to the preventive approach in the way the noble Lord has suggested.