Abstract
ABSTRACTThe Screening for Osteoporosis in Older Women for the Prevention of Fracture (SCOOP) study was a community‐based screening intervention in women aged 70 to 85 years in the United Kingdom. In the screening arm, licensed osteoporosis treatments were recommended in women identified to be at high risk of hip fracture using the FRAX risk assessment tool (including bone mineral density measurement). In the control arm, standard care was provided. Screening led to a 28% reduction in hip fractures over 5 years. In this planned post hoc analysis, we wished to examine for interactions between screening effectiveness on fracture outcome (any, osteoporotic, and hip fractures) on the one hand and baseline FRAX 10‐year probability of hip fracture on the other. All analyses were conducted on an intention‐to‐treat basis, based on the group to which women were randomized, irrespective of whether screening was completed. Of 12,483 eligible participants, 6233 women were randomized to screening, with treatment recommended in 898 (14.4%). No evidence of an effect or interaction was observed for the outcomes of any fracture or osteoporotic fracture. In the screening arm, 54 fewer hip fractures were observed than in the control arm (164 versus 218, 2.6% versus 3.5%), and commensurate with treatment being targeted to those at highest hip fracture risk, the effect on hip fracture increased with baseline FRAX hip fracture probability (p = 0.021 for interaction); for example, at the 10th percentile of baseline FRAX hip probability (2.6%), there was no evidence that hip fractures were reduced (hazard ratio [HR] = 0.93; 95% confidence interval [CI] 0.71 to 1.23), but at the 90th percentile (16.6%), there was a 33% reduction (HR = 0.67; 95% CI 0.53 to 0.84). Prior fracture and parental history of hip fracture positively influenced screening effectiveness on hip fracture risk. We conclude that women at high risk of hip fracture based on FRAX probability are responsive to appropriate osteoporosis management. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.
Highlights
Over the last few years, treatment based on the absolute risk of fracture has been incorporated into many national and international guidelines, given the availability of validated fracture risk assessment tools such as FRAX, launched in 2008.(1,2) For example, in the United Kingdom, specific agedependent intervention thresholds based on 10-year probability of fracture are advocated by the National Osteoporosis Guideline Group in their recent NICE-accredited guidance.[3]
Anti-osteoporosis medications were frequently prescribed in those intervention participants classified as high fracture risk, and so we hypothesized that the effect of screening to reduce hip fractures would be greatest in women with higher baseline FRAX probability, with a consequent interaction between baseline FRAX hip fracture probability and screening effectiveness
After dual-energy Xray absorptiometry (DXA) measurement of femoral neck bone mineral density (BMD) in 2817 women considered to be at moderate/high risk in the screening arm and recalculation of their FRAX hip fracture probabilities, 898 (14.4% of the screening arm) were identified to be at high risk and treatment recommended via their general practitioner
Summary
Over the last few years, treatment based on the absolute risk of fracture has been incorporated into many national and international guidelines, given the availability of validated fracture risk assessment tools such as FRAX, launched in 2008.(1,2) For example, in the United Kingdom, specific agedependent intervention thresholds based on 10-year probability of fracture are advocated by the National Osteoporosis Guideline Group in their recent NICE-accredited guidance.[3]. The approach appears to be acceptable to both patients and GPs.[13] During 5 years of follow-up, prescriptions for antiosteoporosis medications were more frequent, and hip fracture incidence lower, in the screening intervention arm compared with the control arm (Table 1). Anti-osteoporosis medications were frequently prescribed in those intervention participants classified as high fracture risk, and so we hypothesized that the effect of screening to reduce hip fractures would be greatest in women with higher baseline FRAX probability, with a consequent interaction between baseline FRAX hip fracture probability and screening effectiveness
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