Screening For Osteoporosis In Older Women For The Prevention Of Fractures

Osteoporotic fractures, in particular hip fractures present a considerable burden to the National Health Service and to the individual. Around 50% of hip fracture patients lose the ability to live independently and 20% die within a year of their fracture.

The SCOOP study, following on from an 18 month feasibility study, is a UK 7 centre, unblinded, pragmatic, randomised controlled trial lasting 87 months with a minimum of 5 years follow-up. A total of 11 580 women, aged 70 to 85 and not currently on prescription medication to prevent osteoporotic fractures, will be consented into the trial by post via primary care.

Upon receipt of valid baseline data, participants will be randomised to either a screening arm or control arm. Those in the screening arm will have a 10-year fracture probability computed from baseline risk factors together with bone mineral density measured via a DXA scan in selected subjects. Individuals above an age-dependent threshold will be recommended for treatment (typically an oral bisphosphonate) to continue treatment for the duration of the trial.

Study participants are followed-up at 6 months after randomisation and annually by postal questionnaires and checking of hospital radiology and admissions records plus primary care sources. The primary outcome measure will be the proportion of individuals sustaining fractures in each group; hip fracture rate will be a secondary outcome measure. An economic analysis will be carried out to assess cost-effectiveness.

Outputs

Protocol: Shepstone, L., Fordham, R., Lenaghan, E. et al. A pragmatic randomised controlled trial of the effectiveness and cost-effectiveness of screening older women for the prevention of fractures: rationale, design and methods for the SCOOP study. Osteoporos Int 23, 2507–2515 (2012). https://doi.org/10.1007/s00198-011-1876-7

Results: Shepstone L, Lenaghan E, Cooper C, Clarke S, Fong-Soe-Khioe R, Fordham R, Gittoes N, Harvey I, Harvey N, Heawood A, Holland R, Howe A, Kanis J, Marshall T, O'Neill T, Peters T, Redmond N, Torgerson D, Turner D, McCloskey E; SCOOP Study Team. Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial. Lancet. 2018 Feb 24;391(10122):741-747. doi: 10.1016/S0140-6736(17)32640-5. Epub 2017 Dec 16. PMID: 29254858

Cost Effectiveness: David A Turner, Rebekah Fong Soe Khioe, Lee Shepstone, Elizabeth Lenaghan, Cyrus Cooper, Neil Gittoes, Nicholas C Harvey, Richard Holland, Amanda Howe, Eugene McCloskey, Terence W O'Neill, David Torgerson, Richard Fordham, the SCOOP Study Team, The Cost‐Effectiveness of Screening in the Community to Reduce Osteoporotic Fractures in Older Women in the UK: Economic Evaluation of the SCOOP Study, Journal of Bone and Mineral Research, Volume 33, Issue 5, 1 May 2018, Pages 845–851, https://doi.org/10.1002/jbmr.3381

SWATs: Bell, K., Clark, L., Fairhurst, C., Mitchell, N., Lenaghan, E., Blacklock, J., Cushnaghan, J., Cooper, C., Gittoes, N., O'Neill, T. W., Shepstone, L., Torgerson, D. J., & SCOOP Study Team (2016). Enclosing a pen reduced time to response to questionnaire mailings. Journal of Clinical Epidemiology, 74, 144-150. https://doi.org/10.1016/j.jclinepi.2015.12.004

Mitchell, N., Hewitt, C. E., Lenaghan, E., Platt, E., Shepstone, L., Torgerson, D. J., & on behalf of the SCOOP study team (2012). Prior notification of trial participants by newsletter increased response rates: a randomized controlled trial. Journal of Clinical Epidemiology. https://doi.org/10.1016/j.jclinepi.2012.05.008

Other: Söreskog, E., Borgström, F., Shepstone, L. et al. Long-term cost-effectiveness of screening for fracture risk in a UK primary care setting: the SCOOP study. Osteoporos Int 31, 1499–1506 (2020). https://doi.org/10.1007/s00198-020-05372-6

Condurache, C.I., Chiu, S., Chotiyarnwong, P. et al. Screening for high hip fracture risk does not impact on falls risk: a post hoc analysis from the SCOOP study. Osteoporos Int 31, 457–464 (2020). https://doi.org/10.1007/s00198-019-05270-6

Parsons, C., Harvey, N., Shepstone, L. et al. Systematic screening using FRAX^® leads to increased use of, and adherence to, anti-osteoporosis medications: an analysis of the UK SCOOP trial. Osteoporos Int 31, 67–75 (2020). https://doi.org/10.1007/s00198-019-05142-z

Eugene McCloskey, Helena Johansson, Nicholas C Harvey, Lee Shepstone, Elizabeth Lenaghan, Ric Fordham, Ian Harvey, Amanda Howe, Cyrus Cooper, Shane Clarke, Neil Gittoes, Alison Heawood, Richard Holland, Tarnya Marshall, Terence W O'Neill, Tim J Peters, Niamh Redmond, David Torgerson, John A Kanis, the SCOOP Study Team, Management of Patients With High Baseline Hip Fracture Risk by FRAX Reduces Hip Fractures—A Post Hoc Analysis of the SCOOP Study, Journal of Bone and Mineral Research, Volume 33, Issue 6, 1 June 2018, Pages 1020–1026, https://doi.org/10.1002/jbmr.3411

Funding

Funding

Funder:	MRC
Start date:	1/05/2014
End date:	31/12/2020