NICE: New quick spine check for hidden fractures to be added to routine bone scans

Hidden spine fractures affecting around 2.2 million people could be spotted earlier after NICE recommended adding a quick spine check to routine bone scans. 

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 today, NICE says healthcare practitioners should 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 However, the draft guidance recommends that DXA scans are automatically offered without the need for a risk assessment tool to people who have had either a previous hip or vertebral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.  

Eric Power, Interim Director of the Centre for Guidelines at NICE, said:  

"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. 

“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." 

Notes to editors 

• NICE is planning to incorporate all its guidance for osteoporosis, including medicine evaluations, into 1 place to ensure that is as useful and usable as possible. Published for consultation today (13 January 2026) is part 1 and covers assessing fragility fracture risk in adults aged 18 and over and follow up for adults not having treatment. It aims to provide guidance on the selection and use of risk assessment tools in the care of adults at risk of fragility fractures in all NHS settings. This consultation for part 1 closes on 23 February 2026. 

• Part 2 will cover risk assessment for people with learning disabilities, treatment (pharmacological, exercise and calcium and vitamin D), monitoring of treatment and treatment pauses and will include treatment recommendations. Updates and timings will be published on the NICE website. 

• For further information on the NHS DXA bone scanner roll out More scanners across the country for better care of brittle bones - GOV.UK 

• For further information on osteoporosis Royal Osteoporosis Society - Better Bone Health for Everybody 

• 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. Section 2: Introduction to osteoporosis and fragility fractures | NOGG  

About the guidance 

1. Putting recommendations into practice can take time. How long will vary from guideline to guideline, and will depend on how much change in practice or services is needed. Implementing change is most effective when aligned with local priorities.  When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. 

2. Link to draft guidance consultation Osteoporosis guideline for consultation.pdf