Osteoporosis, a condition marked by increased fracture risk, remains under-diagnosed and under-treated worldwide, resulting in a substantial "treatment gap"-the difference between those eligible for osteoporosis treatment and those who actually receive it. While the concept of closing the treatment gap is commendable, and has galvanized clinical and policy efforts, this position statement argues that the prevailing narrative is in danger of becoming disease-focused and parentalistic, neglecting person-centered care. An international consensus group, including public contributors with lived experience were convened to define and characterize the "osteoporosis care gap" as a broader framework, encompassing deficits not only in pharmacological treatment but also in diagnosis, assessment, and multi-disciplinary management. The care gap is thus defined as "the discrepancy between the care provided to those at risk of osteoporotic fractures and best practice, person-centered care." Multi-level determinants of the care gap are identified including: societal-low public awareness underpinned by unhelpful stereotypes, and prevalent health inequalities; health policy-insufficient prioritization, diagnostic confusion, and lack of incentivization; healthcare service-fragmented care pathways with unclear roles and poor communication, inadequate follow-up, and insufficient support for shared decision making; and individual-unmet needs for care which is person-centered, participatory, understandable, equitable, holistic and multidisciplinary, and respects autonomy. The statement calls for a person-centered, equitable, and multidisciplinary approach to osteoporosis care, integrating the perspectives and needs of patients, families, and caregiver. Actions needed at societal and policy level are described, including increasing public awareness, increasing health policy prioritization, with clear professional leadership. The components of osteoporosis care are described in terms of case finding, assessment, treatment, and review. Addressing this, care gap requires coordinated efforts from policymakers, healthcare services, and professionals, with a renewed focus on equity and patient values and preferences.
INTRODUCTION:The IBD UK Benchmarking surveys, conducted in 2019 and 2023, collected repeated data regarding the quality of inflammatory bowel disease (IBD) care across the UK using both service self-assessments and patient-reported experience measures (PREMs). We aimed to assess variation between patient and provider perspectives. METHODS:All UK hospitals offering specialist IBD services were invited to complete online surveys. Patients were invited through social media, charities, and clinical services. This study compared changes over the 4 years and examined alignment between healthcare-reported and patient-reported assessments. RESULTS:From 26 760 patient responses and 154 service assessments, patient-perceived care quality (PPCQ) declined between 2019 and 2023 (P < .001). Male sex and older age were associated with higher PPCQ. Greater disease severity was associated with lower PPCQ (P < .001). More patients reported IBD symptoms to impact activities of daily living in 2023 (P < .001). Factors associated with higher PPCQ included rapid diagnosis, being supported by an IBD team, and having knowledgeable IBD nurses. Access, information, communication, and empowerment were identified by patients as needing improvement (P < .001). Services with lowest quartile quality scores in 2019 demonstrated significant improvement over time, whilst those with highest 2019 scores demonstrated significant deterioration in PPCQ (P < .001). Services reported better performance than patients (P < .001). CONCLUSIONS:These data underscore the importance of assessing lived experience and the care quality perception gap between patients and service providers. Regular benchmarking including PREMs should be used to drive and assess service-level, national and international quality improvement initiatives.
BACKGROUND:IBD is characterised by recurrent flares, but evidence on whether modifiable dietary factors influence flare risk is limited. OBJECTIVE:The PREdiCCt study was designed to examine demographic, clinical and dietary factors associated with disease flare among patients with IBD in self-reported remission. DESIGN:Multicentre, prospective cohort study conducted across 47 UK centres. Patients with Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBDU) in self-reported remission were prospectively followed up. The baseline diet was assessed using a validated food frequency questionnaire. The primary outcome was time to patient-reported flare (captured by monthly IBD-Control) and objective flare (clinical flare plus C-reactive protein >5 mg/L and/or faecal calprotectin (FC) >250 µg/g with treatment escalation). Associations were evaluated using Cox frailty models adjusted for demographic, clinical and biochemical variables, including baseline FC. RESULTS:Between November 2016 and March 2020, 2629 participants (1370 CD; 1259 UC/IBDU) were enrolled and followed up for a median of 4.1 years (IQR 3.0-5.0). Baseline FC was strongly associated with patient-reported flares (FC ≥250 µg/g: adjusted HR (aHR) 2.22; FC 50-250 µg/g: aHR 1.52 (reference <50 µg/g)) and objective flares (FC ≥250 µg/g: aHR 3.25; FC 50-250 µg/g: aHR 1.98). In UC, higher total meat intake was associated with increased risk of objective flares (highest versus lowest quartile: aHR 1.95, 95% CI 1.07 to 3.56). No consistent associations were observed for ultraprocessed foods, fibre or polyunsaturated fatty acids and flare. CONCLUSION:Higher habitual meat intake was associated with increased risk of objective flare in UC, suggesting diet may contribute to flare susceptibility in specific patient groups. TRIAL REGISTRATION NUMBER:NCT03282903.
Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), follow heterogeneous clinical trajectories. Although therapeutic options have expanded substantially over the past two decades, the extent to which modern treatment modifies long-term structural outcomes remains uncertain. We performed a targeted review focusing on high-quality population-based inception cohorts and large registries that report long-term outcomes in adult- and pediatric-onset IBD. Outcomes of interest included phenotype or extent progression, surgery, extraintestinal manifestations (EIMs), and colorectal neoplasia. CD consistently emerged as the more structurally progressive condition. Approximately one third of adults' progress from inflammatory to stricturing or penetrating disease within 5 years, and around half do so over longer follow-up. Perianal disease develops in 10%-20% of patients, with higher rates in pediatric-onset CD. Despite declines in surgical rates in the biologic era, intestinal resection remains frequent. In UC, proximal extension is the dominant progression pattern, affecting roughly one third of patients with limited disease over the first decade; pediatric UC shows even higher extension rates. Colectomy risks have markedly decreased in contemporary cohorts, and colorectal cancer incidence has declined compared with historical estimates, reflecting improved inflammation control and surveillance. Across IBD, EIMs occur in approximately one quarter of patients and cluster with extensive colonic involvement and higher systemic inflammatory burden. Population-based evidence reveals that IBD remains progressive in a substantial subset of patients, with notable differences between CD and UC and between adult and pediatric disease. Declining surgical and colorectal cancer rates suggest a measurable therapeutic era effect, supporting the importance of early, sustained inflammation control. However, high-quality prospective disease-modification trials are still needed to further characterize how current strategies can durably alter the natural history of IBD.
Non-small cell lung cancer (NSCLC) remains the leading cause of cancer mortality in the UK, with most patients presenting with locally advanced or metastatic disease. While palliative radiotherapy has historically aimed to alleviate symptoms, rapid advances in imaging, planning, and delivery-particularly stereotactic ablative body radiotherapy (SABR)-have expanded its role toward disease control. This review summarises the evolving evidence for external beam radiotherapy (EBRT) and SABR in advanced NSCLC. Low-dose thoracic EBRT remains effective for symptom relief, though higher-dose regimens may offer improved control in selected patients. Growing data support the use of local consolidative therapy, particularly SABR, to improve disease control in oligometastatic NSCLC. Trials such as SABR-COMET and that by Gomez et al. demonstrate substantial improvements in progression-free and overall survival with local consolidative therapy, though results are tempered by small sample sizes and heterogeneous populations. Multiple large-scale phase III trials are currently underway to further assess benefits of SABR in oligometastatic cancer and better define dose regimens. Systemic therapies have also rapidly evolved with significant advancements in targeted therapies, immunotherapy, and combination regimens. These are often used alongside radiation therapy, leading to concerns over increased toxicity. Large contemporary randomised trials are underway to update the evidence base in the context of modern systemic therapies. Ultimately, palliative radiotherapy remains central to advanced NSCLC management, with its role expanding from symptom control toward modifying disease progression and improving survival outcomes.
