Shepstone L, et al; “Screening in the community to reduce fractures in older women (SCOOP): a random controlled trial”. Lancet. 2018 Feb 24;391(10122):741-747. doi: 10.1016/S0140-6736(17)32640-5. Epub 2017 Dec 16.
Lee Shepstone, Elizabeth Lenaghan, Cyrus Cooper, Shane Clarke, Rebekah Fong-Soe-Khioe, Richard Fordham, Neil Gittoes, Ian Harvey, Nick Harvey, Alison Heawood, Richard Holland, Amanda Howe, John Kanis, Tarnya Marshall, Terence O’Neill, Tim Peters, Niamh Redmond, David Torgerson, David Turner, Eugene McCloskey; for the SCOOP Study Team*
Commentary: Screening for fracture risk, at the start of this study in 2008, was not currently advocated in the UK, or elsewhere. This study interests me as a nurse, since once properly educated in osteoporosis and appropriate use of clinical evaluation tools, nurses are ideally positioned in Public Health, Long Term Care and Gerontology to provide this screening.
Imagine the healthcare systems cost savings, elders retained independence, and maintained quality of life if we involved our well-trained group of Certified Osteoporosis Nurses to appropriately apply Clinical Evaluation tools in order to help predict and prevent of future fractures.
Background Despite effective assessment methods and medications targeting osteoporosis and related fractures, screening for fracture risk is not currently advocated in the UK. We tested whether a community-based screening intervention could reduce fractures in older women.
Methods We did a two-arm randomised controlled trial in women aged 70–85 years to compare a screening programme using the Fracture Risk Assessment Tool (FRAX) with usual management. Women were recruited from 100 general practitioner (GP) practices in seven regions of the UK: Birmingham, Bristol, Manchester, Norwich, Sheffield, Southampton, and York. We excluded women who were currently on prescription anti-osteoporotic drugs and any individuals deemed to be unsuitable to enter a research study (eg, known dementia, terminally ill, or recently bereaved). The primary outcome was the proportion of individuals who had one or more osteoporosis-related fractures over a 5-year period. In the screening group, treatment was recommended in women identified to be at high risk of hip fracture, according to the FRAX 10-year hip fracture probability. Prespecified secondary outcomes were the proportions of participants who had at least one hip fracture, any clinical fracture, or mortality; and the effect of screening on anxiety and health-related quality of life. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN 55814835.
Findings 12483 eligible women were identified and participated in the trial, and 6233 women randomly assigned to the screening group between April 15, 2008, and July 2, 2009. Treatment was recommended in 898 (14%) of 6233 women. 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. Screening did not reduce the primary outcome of incidence of all osteoporosis-related fractures (hazard ratio [HR] 0·94, 95% CI 0·85–1·03, p=0·178), nor the overall incidence of all clinical fractures (0·94, 0·86–1·03, p=0·183), but screening reduced the incidence of hip fractures (0·72, 0·59–0·89, p=0·002). There was no evidence of differences in mortality, anxiety levels, or quality of life.
Interpretation Systematic, community-based screening programme of fracture risk in older women in the UK is feasible, and could be effective in reducing hip fractures. Funding Arthritis Research UK and Medical Research Council”
This UK article went on to discuss, “… preliminary findings indicate that the cost per prevented osteoporotic related fracture is less than £4500, and the cost per prevented hip fracture is less than £8000. Additionally, the cost per quality-adjusted life-year gained, estimated under various scenarios, was less than £20 000”. The article concluded “…, despite no overall reduction in fractures, findings from this trial show that community screening, based on the FRAX probability of hip fracture, leads to a significant reduction in hip fractures in older women, though this finding needs to be interpreted with caution. Cost-effectiveness analyses are ongoing, but the SCOOP study provides promise of a community-based management strategy that might reduce hip fractures in the UK and elsewhere”.