2 January 2018

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 MRC Lifecourse Epidemiology Unit (LEU) at the University of Southampton the study, known as SCOOP (SCreening for Osteoporosis in Older women for the Prevention of fracture’), compared a screening approach, which involved a questionnaire, bone mineral density measurements in some patients, fracture risk calculated using the online “FRAX” tool and subsequent treatments, to routine care.

It found that there was a 28% reduction in hip fractures over five years in older women who took part in the screening programme.

Researchers involved in the study 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 LEU, 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 FRAX fracture risk tool 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 MRC and Arthritis Research UK.

It involved 12,483 eligible women aged 70 to 85 years, identified from primary care. 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% 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 LEU, 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 are expected to increase with an ageing population, the results of this study have important public health implications.”