WIREDGOV

NICE is recommending that quick spine checks are added to routine bone scans to help spot hidden fractures earlier and prevent serious complications.

Around 70% of spine fractures caused by osteoporosis currently go undiagnosed because they often cause no obvious symptoms at first.

Adding a quick spine check, called a vertebral fracture assessment (VFA), to routine bone scans takes just a few minutes and could allow preventive measures to be taken to avoid significant pain and disability from bone breaks later in life. Spotting hidden fractures early means doctors can offer bone-strengthening treatment to prevent further breaks, maintaining quality of life.

In the draft osteoporosis guideline launching for consultation yesterday (13 January 2026), we recommended healthcare practitioners consider offering these checks during dual energy X ray absorptiometry (DXA) bone mineral density scans, in people aged 50 and over. Evidence shows it is a cost-effective measure as it can be done on the same scanner during the same visit.

People considered at risk of fragility fractures are usually risk assessed by completing a risk prediction tool (either FRAX or QFracture) and if they have a risk score of 10% or more are offered a DXA scan. However, the draft guidance recommends that DXA scans are automatically offered without the need for a risk assessment tool to people who have had either a previous hip or vertebral fragility fracture, or 2 or more fragility fractures, because it is likely they will have a risk score of more than 10%. 

Osteoporosis affects approximately 3.5 million people in the UK, with around 2.95 million in England. It is when your bones lose strength and become more likely to break and it develops slowly over several years. It is often only diagnosed when a fall or sudden impact causes a bone to break.

Fractures of the vertebra, the individual bones in the spine, are one of the most common types of osteoporosis-related fracture and signal the increased likelihood of further bone problems later. Currently in the UK, approximately 549,000 new fragility fractures occur each year, including 105,000 hip fractures, 86,000 vertebral fractures, and 358,000 other fractures. 

The updated recommendations come as the NHS rolls out 13 new DXA bone scanners in hospitals across England, delivering an extra 29,000 scans per year.

Vertebral fractures can have a devastating impact of people’s quality of life. Introducing vertebral fracture assessments during routine bone density scans will help healthcare professionals get the right care to people sooner.

Eric Power, interim director of the centre for guidelines

Eric continues, "Osteoporosis affects millions in England, and this guidance will help healthcare professionals target care towards those people at highest risk, improving their quality of life while making efficient use of NHS resources."

You can now review and comment on this draft guideline. The consultation closes on 23 February 2026 at 5pm.