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Management of Patients With High Baseline Hip Fracture Risk by FRAX Reduces Hip Fractures-A Post Hoc Analysis of the SCOOP Study.

journal contribution
posted on 13.04.2018, 15:21 by E. McCloskey, H. Johansson, N. C. Harvey, L. Shepstone, E. Lenaghan, R. Fordham, I. Harvey, A. Howe, C. Cooper, S. Clarke, N. Gittoes, A. Heawood, Richard Holland, T. Marshall, T. W. O'Neill, T. J. Peters, N. Redmond, D. Torgerson, J. A. Kanis, SCOOP Study Team
The Screening for Osteoporosis in Older Women for the Prevention of Fracture (SCOOP) study was a community-based screening intervention in women aged 70 to 85 years in the United Kingdom. In the screening arm, licensed osteoporosis treatments were recommended in women identified to be at high risk of hip fracture using the FRAX risk assessment tool (including bone mineral density measurement). In the control arm, standard care was provided. Screening led to a 28% reduction in hip fractures over 5 years. In this planned post hoc analysis, we wished to examine for interactions between screening effectiveness on fracture outcome (any, osteoporotic, and hip fractures) on the one hand and baseline FRAX 10-year probability of hip fracture on the other. All analyses were conducted on an intention-to-treat basis, based on the group to which women were randomized, irrespective of whether screening was completed. Of 12,483 eligible participants, 6233 women were randomized to screening, with treatment recommended in 898 (14.4%). No evidence of an effect or interaction was observed for the outcomes of any fracture or osteoporotic fracture. In the screening arm, 54 fewer hip fractures were observed than in the control arm (164 versus 218, 2.6% versus 3.5%), and commensurate with treatment being targeted to those at highest hip fracture risk, the effect on hip fracture increased with baseline FRAX hip fracture probability (p = 0.021 for interaction); for example, at the 10th percentile of baseline FRAX hip probability (2.6%), there was no evidence that hip fractures were reduced (hazard ratio [HR] = 0.93; 95% confidence interval [CI] 0.71 to 1.23), but at the 90th percentile (16.6%), there was a 33% reduction (HR = 0.67; 95% CI 0.53 to 0.84). Prior fracture and parental history of hip fracture positively influenced screening effectiveness on hip fracture risk. We conclude that women at high risk of hip fracture based on FRAX probability are responsive to appropriate osteoporosis management.

History

Citation

Journal of Bone and Mineral Research, 2018, in press

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Medical Education (Pre Nov 2017)

Version

AM (Accepted Manuscript)

Published in

Journal of Bone and Mineral Research

Publisher

American Society for Bone and Mineral Research

issn

0884-0431

eissn

1523-4681

Copyright date

2018

Available date

23/03/2019

Publisher version

https://onlinelibrary.wiley.com/doi/abs/10.1002/jbmr.3411

Notes

The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.

Language

en

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