Screening could catch a quarter of hip fractures before they happen

Community screening
for osteoporosis could prevent more than a quarter of hip fractures in older
women – according to new research involving researchers from the Centre for
Academic Primary Care, University of Bristol and local hospitals, and led by
the University of East Anglia (UEA).

The study,
published today in The Lancet,
reveals that a simple questionnaire, combined with bone mineral density
measurements for some, would help identify those at risk of hip fracture.

The research, which
involved more than 12,000 older women, found that screening through GP
practices allowed patients to be targeted for treatment.

In women agreeing
to participate, this led to a 28 per cent reduction in hip fractures over five
years.

Lead researcher
Professor Lee Shepstone, from UEA’s Norwich Medical School, said:

“Approximately one in three women and one in five men aged over 50 year will
suffer a fragility fracture during their remaining lifetime. In the UK around
536,000 people suffer fragility fractures each year, including 79,000 hip
fractures.

“A hip fracture can
be devastating with a loss of independence and less than one third of patients
make a full recovery. Mortality at one-year post-fracture is approximately 20
per cent.

“We wanted to find
out whether screening, like screening for breast cancer, could help identify
those at risk of suffering a fracture.”

The large
multicentre UK-based community screening study was a collaboration primarily
between UEA and the University of Sheffield, and involved researchers at the
Universities of Southampton, Bristol, Birmingham, Manchester and York, and over
100 primary care practices.

The team used a
University of Sheffield developed tool called FRAX, 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.

A total of 12,483
women aged 70-85 were recruited from 100 GP practices in seven regions
(Birmingham, Bristol, Manchester, Norwich, Sheffield, Southampton, and York).

Half of the women
were screened to compare screening with routine care.

Among those
screened, treatment was subsequently recommended for 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 three quarters 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
compared to the routine care group.

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.

Professor Shepstone
said:

“This is the first trial to show that a community-screening approach
based on the FRAX fracture risk tool is both feasible and effective. Given that
the number of costly and debilitating hip fractures are expected to increase
with an ageing population, the results of this study potentially have important
public health implications.”

Professor Eugene
McCloskey, University of Sheffield, said:

“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. If the SCOOP
screening strategy was taken up in exactly the same way as in the study in all
UK women aged 70-85 years, we estimate that the strategy could prevent up to
8000 hip fractures per year in the UK. Even greater gains could be made
if we could reach out to women similar to those who did not take part in the
study.”

Dr Shane Clarke,
Consultant Rheumatologist and Lead for Osteoporosis Services at Universities
Hospital NHS Bristol said:

“We are very grateful to the GP practices and women
from North Somerset who contributed to this study. The results can have a real
impact on the number of painful hip fractures we see each week in our
hospitals. We are now working through the local Sustainability and
Transformation Plans (STP) to implement the SCOOP programme to benefit patients
in the Bristol area.”

Dr Niamh Redmond,
local study co-ordinator from the Centre for Academic Primary Care, University
of Bristol, said:

“This important research study is the largest and longest of
its kind and successfully worked in partnership with North Somerset GP
practices and their patients. These results provide good quality medical
evidence to GPs about reducing the risk of hip fractures in women in primary
care, supporting their clinical management of these patients.”

The randomised
controlled trial ‘SCreening for Osteoporosis in Older women for the Prevention
of fracture’ (SCOOP) was funded by the Medical Research Council and Arthritis
Research UK.

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% no longer being 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.”

Paper

‘Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial’ Published in The
Lancet.