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 from the University of Sheffield.

A new study published today (15 December 2017) 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.

hip-350The research, conducted in collaboration with the University of East Anglia (UEA), involved more than 12,000 older women and found that screening through GP practices allowed patients to be targeted for treatment.

This led to a 28 per cent reduction in hip fractures over five years in women who participated 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.

The research team used a tool developed by the University of Sheffield 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.

Professor Eugene McCloskey from the Department of Oncology and Metabolism at the 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 it 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 take part in the study.”

The large multi-centre 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 more than 100 primary care practices.

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.

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.”

Professor Shepstone added: “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.”

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 per cent 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.”

‘SCreening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial’

Additional information

FRAX
FRAX® is a simple calculation tool that integrates clinical information in a quantitative manner to predict a 10-year probability of major osteoporotic fracture for both women and men in different countries. The tool was developed at the Centre for Metabolic Bone Diseases, University of Sheffield, in collaboration with international researchers. It assists primary health-care providers to better target people in need of interventions to reduce fracture risk, thus improving the allocation of health-care resources towards patients most likely to benefit from treatment. The FRAX calculator is now freely available for 63 countries and in 34 languages.
For more information visit FRAX

The University of Sheffield
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Contact

For further information please contact:

Amy Huxtable
Media Relations Officer
The University of Sheffield
0114 222 9859
a.l.huxtable@sheffield.ac.uk