Grand Rounds

The SCOOP trial: Does Osteoporosis Screening Reduce Hip Fracture Rates in Older Women?

BACKGROUND AND PURPOSE:

Screening for osteoporosis is not universally advocated
Shepstone et al. (Lancet, 2017) examined whether a community-based screening intervention could reduce fractures in older women

Unblinded two-arm randomized controlled trial (RCT)
SCOOP trial (screening for prevention of fractures in older women)
Participants: Women 70-85 years of age
Exclusion Criteria: On prescription anti-osteoporotic drugs
Intervention group: FRAX questionnaire for screening in all participants, with BMD measurement by dual energy x-ray absorptiometry in a selected subgroup based on higher risk
- Screening based on FRAX 10-year hip fracture probability
- Treatment was recommended in women identified to be at high risk of hip fracture
Control group
- No screening
Primary outcome
- Proportion of individuals who had one or more osteoporosis-related fractures over a 5-year period
Secondary outcomes
- Proportions of participants who had at least one hip fracture
- Any clinical fracture or mortality
- Effect of screening on anxiety and health-related quality of life

12,483 eligible women were identified and participated in the trial
- 6,233 women were randomly assigned to screening
- Treatment was recommended in 14%
Use of osteoporosis medication was higher at the end of year 1 in the screening group compared with controls (15% vs 4%), with uptake particularly high (78% at 6 months) in the screening high-risk subgroup
There was no difference in the primary outcome of incidence of all osteoporosis-related fractures
- Hazard ratio [HR] 0.94, 95% CI 0.85–1.03; p=0·178
There was no difference in overall incidence of all clinical fractures
- HR 0.94, 95% CI 0.86–1.03; p=0.183
There were no differences in mortality, anxiety levels, or quality of life
Screening did reduce the incidence of hip fractures
- HR 0.72, 95% CI 0.59–0.89; p=0.002

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