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Primary care osteoporosis screening ‘could prevent a quarter of hip fractures’

Screening for osteoporosis in GP practices could prevent more than a quarter of hip fractures in older females, according to a UK-wide study.

The research, published in The Lancet, found that a simple questionnaire, combined with bone mineral density measurements for some, would help identify those at risk of hip fracture and allow patients to be targeted for treatment. This led to a 28 per cent reduction in hip fractures over five years.

The large multicentre community screening study, funded by the Medical Research Council and Arthritis Research UK, involved 12,483 women aged 70-85, from 100 GP practices in seven regions – Birmingham, Bristol, Manchester, Norwich, Sheffield, Southampton and York. Half of the women were screened, with the control group receiving routine care.

Some 536,000 people have fragility fractures each year, with hip fractures alone costing £3.5bn in 2010 and expected to rise to £5.5bn by 2025. There is a 20% risk of death in the first year after a hip fracture.

The researchers from UEA and University of Sheffield said: ‘For the individual, a hip fracture can be devastating, causing loss of independence, and less than one-third of patients make a full recovery.’

They used a tool called FRAX, which predicts the probability of a hip fracture or a major osteoporotic fracture, to identify older women at high risk.

Of 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 so that more than three-quarters of the women at high risk were on osteoporosis medication within six months of screening.

Screening did not reduce the incidence of all osteoporosis-related fractures but there was strong evidence for a reduction in hip fractures, with 54 fewer women suffering one or more hip fractures compared with the routine care group.

The study suggests that one hip fracture could be prevented for every 111 women screened and early results suggest the approach is likely to be cost effective.

Professor Lee Shepstone, lead researcher, from UEA’s Norwich Medical School, said: ‘We wanted to find out whether screening, like screening for breast cancer, could help identify those at risk of suffering a fracture.

‘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 is expected to increase with an ageing population, the results of this study potentially have important public health implications.’

Professor Eugene McCloskey, co-lead from the University of Sheffield, said: ‘Low-cost screening with FRAX among the older population could result in effective, targeted intervention to reduce the human and socioeconomic burden of hip fractures.

‘If the screening strategy was taken up in exactly the same way as in the study in all UK women aged 70-85 years, we estimate that the strategy could prevent up to 8,000 hip fractures per year in the UK.

‘Even greater gains could be made if we could reach out to women similar to those who did not take part in the study.’

GPC prescribing lead Dr Andrew Green said: ‘Hip fractures in the elderly are a huge problem, with many causing loss of independence or indeed being the precipitating factor for a general decline in health, so at first glance screening to reduce them would seem of value. However, any potential benefits have to be weighed against both the financial costs and also the known side-effects of osteoporosis treatments. Bisphosphonates in particular carry significant potential adverse effects.

‘No screening should ever take place in the NHS without a positive assessment from the UK Screening Committee, a national funded scheme, and most importantly validated patient decision-making aids so that people choosing to undergo screening do so with full knowledge of the possible benefits and risks.’