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

Related ObG Topics:

ACP Releases Guidance Update on Osteoporosis Treatment

ARCH Study Results: Does Romosozumab Prevent Fracture in Women with Osteoporosis?

Hormonal Contraception Benefits – Beyond Pregnancy Prevention

The VERO Trial Results: Teriparatide vs Risedronate for the Treatment of Osteoporosis

USPSTF Recommendations: Screening for Osteoporosis to Prevent Fractures