Dr Richard Keen, director of the Metabolic Bone Disease Unit at the Royal National Orthopaedic Hospital in Stanmore, north London, said relatively few GPs had signed up to the osteoporosis directed enhanced service, introduced in 2008.

Dr Keen said a 50 year-old woman has a one in two chance of suffering an osteoporosis fracture and two-thirds of sufferers with a vertebral fractures go undetected.

Including a ‘relatively simple and cheap' process in the QOF to identify and register those at risk would cut hospital admissions significantly, he said.

Osteoporosis was one of a number of clinical areas left out of the QOF in 2007 as access targets were included for the first time. 'A lot of work' had been done on QOF indicators before they were omitted, said Dr Keen.

‘There was a political debate on access that meant it didn't get through, but it is a big problem,' Dr Keen told the MIMS women's health conference in London.

NICE guidance recommends female fracture patients over the age of 75 are treated with a bisphosphonate.