Standard operating procedure

Bone Health & Fracture Risk SOP

How [Organisation Name] assesses bone health as part of menopause care, calculates and acts on fracture risk using national tools and thresholds, uses hormone replacement therapy (HRT) as a bone treatment where appropriate, refers patients at very high risk, and tracks every bone investigation and referral to outcome

For Women's Health & Menopause ClinicRef BS-WOM-SOP-011See a sample (PDF) →
£29.99
One-off purchase · no VAT · instant download
  • Instant download after checkout
  • Editable Microsoft Word (.docx)
  • Mapped to the CQC standards
  • Optional 3-monthly updates

What's inside

This standard operating procedure is fully drafted and structured, ready to brand and complete for your service. It covers:

  • 1. Purpose
  • 2. Scope
  • 3. Definitions and abbreviations
  • 4. Responsibilities
  • 5. Equipment, systems and information required
  • 6. Bone health history and clinical risk factors
  • 7. Calculating fracture risk and arranging bone imaging
  • 8. Acting on the fracture risk result
  • 9. HRT and bone health
  • 10. Repeat assessment
  • 11. Lifestyle advice given to every patient
  • 12. Results, referrals and failsafe
  • 13. Safety netting and patient information
  • 14. Records
  • 15. Training and competence
  • 16. Monitoring and audit
  • 17. Related documents
  • 18. Review and version control
  • 19. Disclaimer

CQC fundamental standard

Regulation 9 (Person-centred care)
This document is written to evidence that standard. Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Legislation & standards it maps to

  • National Institute for Health and Care Excellence (NICE) guideline NG23, Menopause: identification and management (as last updated).
  • NICE guideline NG259, Osteoporosis: risk assessment (July 2026), which replaced NICE clinical guideline CG146.
  • National Osteoporosis Guideline Group (NOGG), Clinical guideline for the prevention and treatment of osteoporosis (2024).
  • Royal Osteoporosis Society, Strong, Steady and Straight: UK consensus statement on physical activity and exercise for osteoporosis.
  • British Menopause Society consensus statements and Tools for Clinicians.
  • General Medical Council (GMC), Good practice in proposing, prescribing, providing and managing medicines and devices, including the sections on remote prescribing and on sharing information with a patient's general practitioner.
  • GMC, Remote consultations guidance and decision flowchart.
  • Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in particular Regulation 9 (Person-centred care), Regulation 11 (Need for consent), Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 20 (Duty of candour).
  • Equality Act 2010.
  • UK General Data Protection Regulation and Data Protection Act 2018; Records Management Code of Practice (2023).
  • Care Quality Commission (CQC) assessment framework: the five key questions (safe, effective, caring, responsive and well-led) and the quality statements of the single assessment framework, and the sector-specific framework for primary care and community services when it replaces them.

Who it applies to

All prescribing clinicians (registered with the General Medical Council, the Nursing and Midwifery Council or the General Pharmaceutical Council), the [Clinical Lead], the Registered Manager and administrative and patient-support staff at [Organisation Name], including self-employed and locum clinicians, whether care is delivered in person or remotely

Glossary

Plain-English explanations of the technical terms and legislation used in this document.

Anabolic treatment
An osteoporosis medicine that builds new bone, usually started by a specialist for people at very high fracture risk.
Androgen deprivation therapy
Treatment that lowers sex hormone levels, mainly used for prostate cancer; it weakens bone.
Aromatase inhibitor
A breast cancer medicine that blocks oestrogen production and speeds up bone loss.
Body mass index (BMI)
A measure of weight relative to height.
Bone mineral density (BMD)
How much mineral is in the bone; lower density means weaker bone.
British Menopause Society (BMS)
The UK specialist society for health professionals working in menopause care.
Care Quality Commission (CQC)
The independent regulator of health and social care services in England.
Data Protection Act 2018
The UK law, alongside the UK GDPR, governing how personal information is handled.
Dual-energy X-ray absorptiometry (DXA)
A low-dose X-ray scan that measures bone density at the hip and spine.
Duty of candour
The legal duty to be open and honest with patients when something goes wrong with their care.
Equality Act 2010
The law protecting people from discrimination, including because of sex or gender reassignment.
Failsafe
A tracking system that makes sure no test result or referral is lost or left without action.
Fragility fracture
A broken bone caused by a minor fall or force that would not normally break a healthy bone.
FRAX
An online tool that estimates a person's chance of breaking a bone in the next 10 years.
General Medical Council (GMC)
The regulator of doctors in the UK.
General Pharmaceutical Council (GPhC)
The regulator of pharmacists and pharmacy technicians in Great Britain.
General practitioner (GP)
The patient's family doctor.
Glucocorticoid
A steroid medicine such as prednisolone; long-term use weakens bone.
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
The regulations setting the fundamental standards that registered care providers must meet.
Hormone replacement therapy (HRT)
Medicine that replaces the hormones the ovaries stop making at menopause.
International units (IU)
A standard unit used to measure the dose of vitamins such as vitamin D; 400 IU equals 10 micrograms.
Kyphosis
An abnormal forward curve of the upper spine, sometimes caused by vertebral fractures.
Medicines and Healthcare products Regulatory Agency (MHRA)
The UK regulator of medicines and medical devices.
National Institute for Health and Care Excellence (NICE)
The body that publishes national clinical guidelines for England.
National Osteoporosis Guideline Group (NOGG)
The UK expert group that publishes the national osteoporosis guideline and fracture risk treatment thresholds.
NICE NG23
The NICE guideline Menopause: identification and management.
NICE NG259
The NICE guideline Osteoporosis: risk assessment (2026), which replaced the older guideline CG146.
Nursing and Midwifery Council (NMC)
The regulator of nurses and midwives in the UK.
Osteoporosis
A condition in which bones become thin and fragile and break more easily.
Premature ovarian insufficiency (POI)
When the ovaries stop working normally before the age of 40.
QFracture
An alternative online tool that estimates the chance of a fracture over time.
Records Management Code of Practice (2023)
National guidance on how long health records are kept and how they are managed.
Royal Osteoporosis Society
The UK charity for bone health and osteoporosis, which publishes patient information and exercise guidance.
Standard Operating Procedure (SOP)
A written, step-by-step instruction for carrying out a task consistently and safely.
T-score
A DXA result comparing bone density with a healthy young adult; -2.5 or lower means osteoporosis.
UK General Data Protection Regulation (UK GDPR)
The UK's main data protection law.
Venous thromboembolism (VTE)
A blood clot in a vein, such as a deep vein thrombosis or a clot in the lung.
Vertebral fracture assessment (VFA)
A spine image, usually taken during a DXA scan, to look for fractures of the vertebrae.
Vitamin D
A vitamin needed to absorb calcium and keep bones healthy, made in the skin in sunlight and found in some foods.

How it works

  1. Buy securely with Stripe - instant, no VAT, no account needed.
  2. Download your editable Word file from the link we email you straight away.
  3. Complete the placeholders for your service, then have it approved before use.
  4. Add the optional updates subscription and we keep it current as guidance changes.

Related documents

PolicyWomen's Health Scope of Service Policy£44.99
PolicyMenopause Assessment & Diagnosis Policy£44.99
PolicyHRT Prescribing Policy£44.99
PolicyTestosterone Prescribing in Women Policy£44.99

Need the whole set?

Buy the full Women's Health & Menopause Clinic pack and save versus buying documents individually.

View the Women's Health & Menopause Clinic pack →