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Screening prevents hip fractures in older women

Screening for fracture risk led to a statistically significant reduction in hip fractures among older women, according to data published in The Lancet.

“Approximately one in three women and one in five men aged over 50 years will suffer a fragility fracture during their remaining lifetime,” Lee Shepstone, PhD, from University of East Anglia’s Norwich Medical School, England, said in a press release. “A hip fracture can be devastating with a loss of independence and less than one third of patients make a full recovery. Mortality at 1-year post-fracture is approximately 20%.”

Shepstone and colleagues performed a randomized controlled trial to assess the efficacy of a community-based screening program using the Fracture Risk Assessment Tool for the reduction of fractures in older women compared with usual management.

The researchers included 12,483 women aged between 70 and 85 years from 100 general practitioner practices in England. Women taking prescription anti-osteoporotic drugs and those deemed unsuitable, including those with dementia or a terminal illness, were excluded from the study. Participants were randomly assigned to either the screening (n = 6,233) or control group (n = 6,250).

Data showed that 14% of women in the screening group were considered to be at high-risk for hip fractures and were recommended to undergo treatment. At the end of the first year, more women in the screening group used osteoporosis medication than controls (15% vs. 4%). Uptake of osteoporosis medication was especially high among women with high risk in the screening group: 78% were using osteoporosis drugs at 6 months.

Screening resulted in a markedly lower incidence of hip fractures (HR = 0.72; 95% CI, 0.59-0.89; P = 0.002). However, the overall incidences of all osteoporosis-related fractures (HR = 0.94; 95% CI, 0.85–1.03) and all clinical fractures (HR = 0.94; 95% CI, 0.86–1.03) were not reduced by screening over 5 years. Mortality, anxiety levels and quality of life did not differ between the groups.

“Our data has the potential to influence national policies around prevention of hip fractures, which is particularly relevant in our ageing society... While we have demonstrated clinical effectiveness of screening, we are also exploring cost-effectiveness of this approach; initial analyses also look promising in this respect,” Neil Gittoes, PhD, coauthor from the University of Birmingham’s Institute of Metabolism and Systems Research, said in the release. – by Alaina Tedesco

Disclosure: Shepstone reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.