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Screening could reduce fractures in older women

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Community-based screening for osteoporosis could prevent more than a quarter of hip fractures in older women, according to research led by the University of East Anglia (UEA).

The study found that a simple questionnaire, combined with bone mineral density measurements for some, would help identify those at risk of hip fracture.

More than 12,000 women aged 70-85 years were involved in the research, which compared a screening programme using the Fracture Risk Assessment Tool (FRAX) with usual management. The researchers wanted to to find out whether screening, like screening for breast cancer, would allow patients to be targeted for treatment.

Developed by the University of Sheffield, FRAX predicts the probability of a hip fracture or a major osteoporotic fracture (hip, spine, upper arm or lower arm fracture), to identify older women at high risk.

Half of the women were screened, in order to compare screening with routine care. Among those screened, treatment was subsequently recommended for one in seven women deemed at high risk of hip fracture. This recommendation was acted upon by the women and their GPs, resulting in over three quarters of the women at high risk being on osteoporosis medications within six months of screening.

According to UEA, screening did not reduce the incidence of all osteoporosis-related fractures but there was a 28% reduction in hip fractures over five years.

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.

Lead researcher Prof Lee Shepstone, from UEA’s Norwich Medical School, said: “This is the first trial to show that a community-screening approach based on the FRAX fracture risk tool is both feasible and effective. Given that the number of costly and debilitating hip fractures are expected to increase with an ageing population, the results of this study potentially have important public health implications.”

Prof Eugene McCloskey, from the University of Sheffield, added that if a similar screening strategy was adopted across the UK, it’s estimated that up to 8,000 hip fractures could be prevented every year.

The findings of the research have been published in The Lancet.