A short questionnaire, followed by a bone density scan for some patients, could prevent more than a quarter of hip fractures in older women. That is the main finding of the SCOOP trial, published in The Lancet on December 15, 2017.
SCOOP stands for SCreening for Osteoporosis in Older women for the Prevention of fracture. The study enrolled 12,483 women aged 70 to 85 through 100 GP practices in seven regions of England: Birmingham, Bristol, Manchester, Norwich, Sheffield, Southampton and York. Half of the women were screened, while the other half received routine care.
Screening relied on FRAX, a tool developed at the University of Sheffield. It combines clinical information to estimate the chance of a hip fracture or another break linked to osteoporosis. About one in seven screened women was found to be at high risk and was advised to start treatment. After six months, more than three quarters of them were already taking osteoporosis medicine.
Still, the results were clearest for hips. Among women who took part, screening cut hip fractures by 28 percent over five years. The screened group had 54 fewer women with at least one hip fracture, which means one fracture was avoided for every 111 women screened. Screening did not lower the rate of all osteoporosis-related fractures, however. Early analysis also suggests the approach is likely to be cost-effective.
The stakes are high, though. In the UK, about 536,000 people suffer fragility fractures each year, including 79,000 hip fractures. Fewer than a third of hip fracture patients recover fully, and about 20 percent die within a year.
Lead researcher Professor Lee Shepstone of the University of East Anglia’s Norwich Medical School said it was the first trial to show that community screening based on FRAX is both feasible and effective. Professor Eugene McCloskey of the University of Sheffield estimated that the strategy could prevent up to 8,000 hip fractures a year if it were offered to all UK women aged 70 to 85.
In Bristol, doctors are already working with local health planners to put SCOOP into practice. The trial was led by UEA and Sheffield, with researchers from Southampton, Bristol, Birmingham, Manchester and York. It was funded by the Medical Research Council and Arthritis Research UK.