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Medicine

A lifecourse approach to reducing the burden of osteoporotic fractures

Research at the University of Southampton’s MRC Lifecourse Epidemiology Unit (LEU) has influenced government policy and clinical guidelines in the UK and internationally, leading to improved bone density in younger people and a reduction in osteoporosis and fracture rates in older age.

Context

A common cause of age-related fractures, osteoporosis constitutes a major public health problem costing the NHS up to £4 billion a year.

Osteoporotic fractures

Led by Professor Cyrus Cooper and Professor Nicholas Harvey, research at the MRC Lifecourse Epidemiology Unit (LEU) has demonstrated a clear treatment gap in primary and secondary prevention of osteoporotic fractures.

However, the work by the MRC LEU addresses these urgent healthcare priorities and the longer-term need to incorporate bone health into population-level strategies and has supported new interventions that aim to maximise peak bone mass in early adulthood, and to minimise fracture risk in older age.

Fracture Liaison Services

MRC LEU research has supported the implementation of Fracture Liaison Services (FLSs), which identify older patients presenting, typically to A&E, with a fracture, and ensure that they receive appropriate assessment and treatment for osteoporosis, to minimise the risk of sustaining a further fracture event. A 2003-2013 longitudinal study showed the positive impact of FLS models of post-fracture care on subsequent mortality, and a trend towards reduction in second hip fracture.

The research informed the global standard of care in FLS, set out by the International Osteoporosis Foundation’s Capture the Fracture initiative, which provides international quality standards for global benchmarking, key performance indicators and practical support.

Capture the Fracture led to the operationalisation of more than 400 registered FLSs across 46 countries, directly improving patient care.

Screening for fracture risk in older age

The MRC LEU conducted the first worldwide study (SCOOP trial 2008-2014, alongside the Universities of Sheffield and East Anglia) to assess screening for fracture risk using age-dependent treatment thresholds based on 10-year fracture probabilities.

The SCOOP results, together with Royal Osteoporosis Society-funded studies, underpinned the assessment of disease burden and risk stratification in recommendations by the National Osteoporosis Guideline Group (NOGG).

The NOGG recommendations form the basis of European guidance for the diagnosis and management of osteoporosis in postmenopausal women, are accredited by NICE and are incorporated into the NICE Quality Standards and Osteoporosis Treatment Pathway.

The work also informed the WHO Report on Ageing and Health 2016.

Maternal vitamin D supplementation in pregnancy and offspring musculoskeletal development

MRC LEU research focusing earlier in the lifecourse has documented links between maternal pregnancy vitamin D intake and offspring bone development. A unique randomised, double-blind, placebo-controlled trial (MAVIDOS, 2008-2014) demonstrated that gestational vitamin D supplementation led to a marked improvement in offspring bone mass at birth.

The MAVIDOS trial informed the 2016 recommendations for maternal vitamin D supplementation during pregnancy from the UK Scientific Advisory Committee on Nutrition, which were translated into guidance by Public Health England (PHE). The PHE guidance incorporated seasonal stratification into supplementation advice, which fed into the WHO Minsk Declaration. From this, European Member States formally adopted the lifecourse approach as the basis for improving population health and wellbeing.

MAVIDOS received widespread global media coverage and subsequently informed other guidelines internationally, for example from the Australian Department of Health.

 

Related projects

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