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Grand Rounds

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

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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

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

  • Osteoporosis screening was feasible and reduced the incidence of hip fractures
  • 111 individuals would need to be screened to avoid 1 hip fracture
  • Cost-effectiveness study is ongoing

Learn More – Primary Sources:

Screening in the community to reduce fractures in older women (SCOOP): a randomized controlled trial

FRAX® Fracture Risk Assessment Tool

 

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