Community-based screening can substantially reduce hip fractures in women
The risk of hip fractures in women could be reduced through a community screening programme, a new study has shown.
Published in The Lancet and involving scientists from the University of Southampton, the study reveals that a simple questionnaire, combined with bone mineral density measurements for some and a fracture risk score, would help identify those at risk of hip fracture.
It led to a 28 per cent reduction in hip fractures over five years in older women who took part in the screening programme.
Researchers involved in the study, known as SCOOP (SCreening for Osteoporosis in Older women for the Prevention of fracture), believe the low-cost strategy could prevent thousands of women from suffering hip fractures each year.
Nicholas Harvey, Professor of Rheumatology and Clinical Epidemiology at the MRC Lifecourse Epidemiology Unit, University of Southampton, and a co-author of the study, said: “This is the first trial to show that a community-screening approach based upon the tools used is feasible, and importantly, effective at reducing the risk of these devastating fractures. We estimate that if the strategy could be implemented exactly as in the SCOOP study, it could prevent up to 8,000 hip fractures per year.”
The large multicentre UK-based study was a collaboration primarily between the Universities of East Anglia and Sheffield and involved researchers at the Universities of Southampton, Bristol, Birmingham, Manchester and York, and over 100 primary care practices. It was funded by the Medical Research Council and Arthritis Research UK.
It involved 12,483 eligible women aged 70 to 85 years, identified from primary care and used a tool called FRAX, developed by the University of Sheffield, which predicts the probability of a hip fracture or a major osteoporotic fracture (a hip, spine, upper arm or lower arm fracture), to identify older women at high risk.
In the women randomised to screening, treatment was subsequently recommended in approximately one in seven women deemed at high risk of hip fracture. This recommendation was acted upon by the women and their GPs so that over 75 per cent of the women at high risk were on osteoporosis medications within six months of screening.
While screening did not reduce the incidence of all osteoporosis-related fractures, there was strong evidence for a reduction in hip fractures. In the screening group, there were 54 fewer women who suffered one or more hip fractures (total number of hip fractures 164), compared to the routine care group in which there were 218 hip fractures. The study suggests that one hip fracture could be prevented for every 111 women screened and early analysis suggests the approach is likely to be cost-effective.
Cyrus Cooper, Professor of Rheumatology and Director of the MRC Lifecourse Epidemiology Unit, University of Southampton, and a co-author of the study, commented: “This trial, which informs a potential major alteration to national policies aimed at the prevention of osteoporotic fractures, demonstrates the critical importance of such institutional collaboration across the UK in addressing fundamental public health problems. It is only with investment in such studies, and their subsequent adoption into policy, that we can address the immense public health burden caused by osteoporosis and related fractures.”
Professor Lee Shepstone, of the University of East Anglia, who led the SCOOP study, added: “Given that the number of costly and debilitating hip fractures is expected to increase with an ageing population, the results of this study have important public health implications.”
Dr Natalie Carter, head of research liaison and evaluation at Arthritis Research UK, said: “Ten of thousands of people a year present with hip fractures in the UK. As well as significantly increasing mortality, a hip fracture can stop a person’s ability to live independently, with 43 per cent no longer able to walk independently in the year after the fracture.
“We welcome this community-based screening programme and any other research that reduces the likelihood of fractures.”
Related Staff Member
Professor Cyrus Cooper OBE, MA, DM, FRCP, FFPH, FMedSci
Cyrus Cooper is Professor of Rheumatology and Director of the MRC Lifecourse Epidemiology Unit; Vice-Dean of Medicine at the University of Southampton; and Professor of Musculoskeletal Science at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford.
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Professor Nicholas C W Harvey MA, MB, BChir, PhD, FRCP
Professor Nicholas Harvey is Professor of Rheumatology and Clinical Epidemiology within Medicine at the University of Southampton.
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