Posted on 18 December 2017
A major study reported in The Lancet has revealed that a simple questionnaire combined with bone mineral density measurements for some, could help identify individuals at risk of hip fractures, allowing them to be offered preventative treatment before fractures occur.
Around 79,000 people in the UK, many of them older women, suffer hip fractures each year and due an ageing population that number is set to increase. The injury is often accompanied by a devastating loss of independence, with less than one third of patients making a full recovery.
The new study, which involved more than 12,000 women aged 70 to 85, found that screening through GP practices allowed patients to be targeted for osteoporosis treatment, a step which led to a 28% reduction in hip fractures over five years in the women who agreed to participate.
Women from North Yorkshire
Collaborator on the study, Professor David Torgerson from the Department of Health Sciences, said: "More than 2,000 women from the North Yorkshire region were involved in this important study, which is one of the largest trials of fracture prevention in the world."
Of the 12,483 women involved in the trial, half were screened so that screening could be compared with routine care. Among those screened, treatment was subsequently recommended for one in seven women deemed at high risk of hip fracture. 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.
The multi-institutional research team was led by academics at the universities of East Anglia and Sheffield and involved researchers from five other universities including Manchester, Birmingham and York, in addition to 100 primary care practices. The researchers used a tool developed at the University of Sheffield called FRAX, a simple calculation tool that integrates clinical information to predict the probability of a hip or other osteoporosis-related fracture to identify women at high risk.
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% 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.”
The randomised controlled trial “Screening for Osteoporosis in Older women for the Prevention of fracture” (SCOOP) is reported in The Lancet and was funded by the Medical Research Council and Arthritis Research UK.