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High-risk patients, such as older women, are most likely to benefit.
• While screening for osteoporosis does not reduce the overall fracture rate, it may reduce total hip fractures over the following 5 years.
• Screening for osteoporosis may be of particular benefit in high-risk patients such as older women.
Hip fractures can have devastating consequences. They may lead to loss of independence and ultimately death within 1 year in approximately 20% of those affected.
Dr. Lee Shepstone and colleagues at Norwich Medical School in the United Kingdom sought to determine whether a screening tool could help identify patients at higher risk for fracture.
The researchers conducted a two-arm randomized controlled trial using the Fracture Risk Assessment Tool (FRAX) in women aged 70 to 85 years.1 The FRAX tool was designed to predict the likelihood of hip or major osteoporotic fracture in older high-risk women. Included in the study were 12,483 women; half were screened for osteoporosis and half received routine care. The groups were compared for fracture at follow-up.
• Treatment was recommended for osteoporosis in 14% of women in the screening group.
• Screening did not reduce the incidence of osteoporosis-related fractures (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.85-1.03; P = 0.178).
• Screening did not reduce the incidence of all clinical fractures (HR, 0.94; 95% CI, 0.86-1.03; P = .183).
• Screening did reduce the number of hip fractures (HR, 0.72; 95% CI, 0.59-0.89; P = .002).
• No differences existed between groups with regard to mortality, anxiety, or quality of life.
Implications for physicians
• While total numbers of fractures are not reduced, screening may reduce the number of hip fractures, a significant cause of morbidity and mortality in the aging population.
• “Low-cost screening with FRAX among the older population could result in effective, targeted intervention to reduce the human and socioeconomic burden of hip fractures,” said study author Dr. Eugene McCloskey at the University of Sheffield in the United Kingdom.
• Consider routinely screening patients for osteoporosis as they age in an effort to target treatment early to prevent hip fractures in this high-risk group.
• One hip fracture could be prevented for every 11 women screened.
The Arthritis Research UK and Medical Research Council funded this study.
1. Shepstone L, Lenaghan E, Cooper C, et al; SCOOP Study Team. Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial. Lancet. 2017 Dec 15. pii: S0140-6736(17)32640-5. doi: 10.1016/S0140-6736(17)32640-5. [Epub ahead of print]