Image: A FRAX score calculation example (Photo courtesy of Imagemag).
A new study suggests that a systematic, community-based screening program in older women could be effective in reducing hip fractures.
Researchers at the University of East Anglia (UEA; Norwich, United Kingdom), the University of Sheffield (United Kingdom), the University of Bristol (United Kingdom), and other institutions conducted a randomized controlled trial involving 12,483 women (70-85 years of age) in order to compare a screening program that used the Fracture Risk Assessment Tool (FRAX) with standard care. Participating women were recruited from 100 general practitioner practices in seven regions of the UK: Birmingham, Bristol, Manchester, Norwich, Sheffield, Southampton, and York.
Women who were currently on prescription anti-osteoporotic drugs and any individuals deemed to be unsuitable to enter a research study were excluded from the study. In the screening group, treatment was recommended to women identified to be at high risk of hip fracture according to the FRAX 10-year hip fracture probability. The primary outcome was proportion of osteoporosis-related fractures over a five-year period, with secondary outcomes being proportions of subjects with at least one hip fracture, any clinical fracture, or mortality, and the effect of screening on anxiety and health-related quality of life.
The results revealed that in the screening group, treatment was recommended in 14% of 6,233 women. Use of osteoporosis medication was higher at the end of year one in the screening group (15%), as compared to controls (4%), with uptake particularly high in the screening high-risk sub-group. While screening did not reduce the primary outcome of incidence of all osteoporosis-related fractures, nor the overall incidence of all clinical fractures, it did reduce the incidence of hip fractures by 27%. There were no differences in mortality, anxiety levels, or quality of life. The study was published on December 15, 2017, in The Lancet.
“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%,” said lead author Professor Lee Shepstone, PhD, of UEA. “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 is expected to increase with an ageing population, the results of this study potentially have important public health implications.”
“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,” concluded senior author Professor Eugene McCloskey, MD, of the University of Sheffield. “We estimate that the strategy could prevent up to 8,000 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.”
University of East Anglia
University of Sheffield
University of Bristol