Osteoporosis screening could massively reduce hip fractures
Screening for osteoporosis could prevent a huge amount of hip fractures in older women, a new study has revealed.
The research, led by the University of East Anglia (UEA), showed that by getting women to take a simple questionnaire, combined with bone mineral density measurements for some, doctors would be able to identify those at risk.
The study, published in The Lancet, involved more than 12,000 older women, and found that screening through GP practices successfully allowed patients to be targeted for treatment.
Among women agreeing to participate, this led to a 28% reduction in the amount of hip fractures over a five year period.
Lead researcher Professor Lee Shepstone said, “Approximately one in three women and one in five men aged over 50 years 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.
“We wanted to find out whether screening, like screening for breast cancer, could help identify those at risk of suffering a fracture.”
The team used a tool called FRAX, developed at the University of Sheffield, which predicts the probability of a hip fracture or a major osteoporotic fracture (hip, spine, upper or lower arm) 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 across the country.
Half of the women recruited were screened, to compare screening with routine care.
Among the women screened, one in seven was deemed at high risk of hip fracture and recommended treatment.
This recommendation was acted upon by the women and their GPs, and over three quarters of those at high risk were on osteoporosis medications within six months of screening.
Although screening did not reduce the incidence of all osteoporosis-related fractures, there was strong evidence for a reduction in hip fractures.
Of the women in the screening group, 54 fewer than in the routine care group suffered one or more hip fractures.
Osteoporosis is a disease that causes an increased loss of bone mass and strength, leading to higher risk of fractures.
As it is normally symptomless, it is often not discovered until someone does get a fracture, usually in the back or hips.
Until the age of 30, a person will normally build more bone than they lose, but as you age your bones begin to break down faster than they build up.
Once bone loss reaches a certain point, this is classed as osteoporosis.
There is a relation between lack of oestrogen in women during menopause and development of osteoporosis.
The study suggests that one hip fracture could be prevented for every 111 women screened, and 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 of the University of Sheffield added, “If the screening strategy was taken up in exactly the same way in all UK women aged 70-85 years, we estimate that this 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.”
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, “Tens 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.”