Community-based screening may reduce hip fracture risk in older women
medwireNews: Results of the UK SCOOP trial suggest that screening for osteoporosis-related fracture risk in older women is feasible and may reduce the incidence of hip fractures relative to standard care.
As reported in The Lancet, Lee Shepstone (University of East Anglia, Norwich, UK) and co-investigators randomly assigned 12,483 women aged 70–85 years who were not receiving osteoporosis treatment at baseline to participate in screening using the Fracture Risk Assessment Tool (FRAX) or to receive usual care.
Participants in the intervention group were categorized as having low or high 10-year fracture risk for their age based on FRAX screening results, and those in the high-risk group underwent subsequent bone mineral density assessment to determine their final risk category. Patients at high risk for fracture were then advised to discuss treatment options with their primary care provider.
After 1 year, 15% of participants in the screening group were using osteoporosis medication, compared with 4% of those in the usual care group, and medication use was particularly high among women who were in the high fracture risk category, with 78% having received treatment within 6 months.
Over 5 years of follow-up, the proportion of women who experienced an osteoporosis-related fracture – the primary trial outcome – was similar in the screening and usual care groups, at 12.9% versus 13.6%, giving a hazard ratio (HR) of 0.94 after adjustment for geographical region, baseline fracture risk, and falls.
However, in a prespecified analysis of secondary outcomes, women in the screening group had a significant 28% lower risk for hip fracture than those in the usual care group, with rates of 2.6% versus 3.5%.
“The absolute size of the decrease in hip fracture rates was 0.9%, which would require 111 individuals to be screened to avert one hip fracture,” explain Shepstone and colleagues.
Although screening was associated with a “marked reduction” in hip fracture risk, the researchers caution that “conclusions based on secondary outcomes need to be treated with a degree of caution and should not be overemphasised.”
Nevertheless, the author of an accompanying commentary, Jane Cauley (University of Pittsburgh, Pennsylvania, USA), believes that despite the lack of impact of screening on the primary outcome, the trial results “have important public health implications” given that “[h]ip fractures are the most devastating consequence of osteoporosis with substantial loss of independence, morbidity, and mortality.”
Shepstone et al also found no differences in quality of life or anxiety levels among women in the intervention and usual care groups, suggesting that “screening was acceptable” to participants.
And the team concludes: “Cost-effectiveness analyses are ongoing, but the SCOOP study provides promise of a community-based management strategy that might reduce hip fractures in the UK and elsewhere.”
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