Screening with FRAX reduces hip fractures

19 December 2017

The results of a large multi-centre community screening study helped reduce hip fractures in older women, thanks to the FRAX fracture risk tool and subsequent osteoporosis management.

University Hospitals Birmingham NHS Foundation Trust (UHB) worked on the study, led by Professor Neil Gittoes, in collaboration with many universities, including the Universities of East Anglia, Sheffield, Southampton, Bristol, Manchester and York.

The approach, based on a simple questionnaire combined with bone mineral density measurements in some individuals, targeted licensed osteoporosis treatments to women through their local GP practices and resulted in a 28% reduction in hip fractures over 5 years.

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.

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 and compared screening with the FRAX tool to routine care.

Over 12,000 eligible women aged 70 – 85 were identified by GPs and other primary care workers.

In the half of the women randomised to screening, treatment was subsequently recommended in approximately one in seven 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.

Prof Lee Shepstone of the University of East Anglia stated: “This is the first trial to show that a community-screening approach based upon 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.”

Prof Eugene McCloskey, University of Sheffield, added that “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 implemented as in the SCOOP study, we estimate that the strategy could prevent up to 8000 hip fractures per year in the UK”.