Section 10: Recommendations for training

It is recommended that:

1. Training in personalised care, including shared decision making, is provided within all higher professional training curricula in relevant medicine and surgical specialities (Strong recommendation).
2. Training in osteoporosis and metabolic bone diseases is a clearly articulated component of each of the relevant medical and surgical specialities higher professional training curricula set out by the applicable medical and surgical Royal Colleges (Strong recommendation).
3. Primary care physicians have sufficient training in this area with efficient access to up-to-date evidence-based resources and guidelines, and continual professional development (CPD) opportunities to maintain and refine knowledge (Strong recommendation).
4. The management of osteoporosis is a component of training in all relevant allied health disciplines (Strong recommendation).
5. Training should be provided to Fracture Liaison Service personnel to achieve high quality DXA performance and reporting (Strong recommendation).
6. Quality improvement training should be provided to healthcare personnel responsible for the delivery of Fracture Liaison and/or Osteoporosis Services (Strong recommendation).

1. The management of osteoporosis and fragility fracture risk is not subserved by any one specialty. The relevant medical and surgical specialties include general practice, rheumatology, orthopaedic surgery, endocrinology, metabolic medicine, geriatric medicine, and obstetrics and gynaecology. Furthermore, the care of patients with osteoporosis is the responsibility of multiple healthcare professionals, including nurses, physiotherapists, occupational therapists, pharmacists and DXA operators. The multi-disciplinary nature of osteoporosis care offers opportunities for cross-speciality training.
2. It is recognised that primary care is pivotal to the identification of the population at risk of fragility fractures as well as to the long-term management of patients with osteoporosis. It is important that primary care physicians have sufficient training in this area, with access to resources such as updated guidelines and online learning modules to refresh their knowledge.
3. Common to all healthcare roles is a need to provide personalised patient-centred care, a key commitment outlined by the NHS to be achieved by 2023/24. Personalised care is a partnership approach that helps people make informed decisions and choices about their health and wellbeing, working alongside clinical information [Personalised Care Institute 2020].
4. There is significant variability in the access to and quality of DXA services for established FLS worldwide. Despite two decades of training initiatives in osteoporosis densitometry, many centres are falling short of the standards of the IOF-ISCD Osteoporosis Essentials criteria ³⁰⁸.
5. Improving quality of osteoporosis and fracture liaison services is about making health care delivery safe, effective, patient-centred, timely, efficient and equitable. Quality improvement involves the use of a systematic and coordinated approach to solving a problem using specific methods and tools with the aim of bringing about a measurable improvement within a health care setting ³⁰⁹, and can be aided by the use of appropriate Toolkits (e.g. the Royal Osteoporosis Society Fracture Liaison Service Implementation Toolkit).

The Personalised Care Institute is a virtual organisation, accountable for setting the standards for evidence-based training in personalised care in England. The Personalised Care Institute Curriculum sets out the standards for training programmes to become accredited with the Personalised Care Institute. The Personalised Care Institute provides eLearning modules for example on Shared Decision Making. The curriculum is designed for health care personnel within primary and secondary care and community teams https://www.personalisedcareinstitute.org.uk.

The Royal Osteoporosis Society Fracture Prevention Practitioner Training is accredited for CPD by RCGP, RCP and RCN. The online training includes five foundation modules and then three advanced modules https://theros.org.uk/healthcare-professionals/courses-and-cpd/fracture-prevention-practitioner-training/
The Royal College of General Practice also provides a short e-Learning module on the diagnosis and management of osteoporosis https://elearning.rcgp.org.uk/course/info.php?id=233

The Health Education England e-Learning for Healthcare Pain Management programme includes training on musculoskeletal pain which encompasses the assessment and management of osteoporotic vertebral fractures https://www.e-lfh.org.uk/programmes/pain-management/.

The Royal Osteoporosis Society run a Bone Densitometry Foundation Course. This online course provides a foundation in osteoporosis and DXA (https://theros.org.uk/healthcare-professionals/courses-and-cpd/bone-densitometry-foundation-course/).