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Showing content from https://pubmed.ncbi.nlm.nih.gov/31220365 below:

The Effect of a Screening and Treatment Program for the Prevention of Fractures in Older Women: A Randomized Pragmatic Trial

Randomized Controlled Trial

Affiliations

• ¹ Amsterdam UMC, Vrije Universiteit Amsterdam, General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
• ² Stichting Artsen Laboratorium en Trombosedienst, Koog aan de Zaan, Netherlands.
• ³ Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
• ⁴ Jeroen Bosch Ziekenhuis, Department of Orthopaedics, 's-Hertogenbosch, Netherlands.
• ⁵ Amsterdam UMC, Vrije Universiteit Amsterdam, Internal Medicine, Endocrine Section, Amsterdam, Netherlands.

• PMID: 31220365
• PMCID: PMC6900199
• DOI: 10.1002/jbmr.3815

Item in Clipboard

Randomized Controlled Trial

Thomas Merlijn et al. J Bone Miner Res. 2019 Nov.

• ¹ Amsterdam UMC, Vrije Universiteit Amsterdam, General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
• ² Stichting Artsen Laboratorium en Trombosedienst, Koog aan de Zaan, Netherlands.
• ³ Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
• ⁴ Jeroen Bosch Ziekenhuis, Department of Orthopaedics, 's-Hertogenbosch, Netherlands.
• ⁵ Amsterdam UMC, Vrije Universiteit Amsterdam, Internal Medicine, Endocrine Section, Amsterdam, Netherlands.

• PMID: 31220365
• PMCID: PMC6900199
• DOI: 10.1002/jbmr.3815

Item in Clipboard

Population screening for fracture risk may reduce the fracture incidence. In this randomized pragmatic trial, the SALT Osteoporosis Study (SOS), we studied whether screening for fracture risk and subsequent treatment in primary care can reduce fractures compared with usual care. A total of 11,032 women aged 65 to 90 years with ≥1 clinical risk factor for fractures were individually randomized to screening (n = 5575) or usual care (n = 5457). Participants in the screening group underwent a screening program, including bone densitometry and vertebral fracture assessment. Participants with a high 10-year fracture probability (FRAX) or a vertebral fracture were offered treatment with anti-osteoporosis medication by their general practitioner. Incident fractures as reported by questionnaires were verified with medical records. Follow-up was completed by 94% of the participants (mean follow-up = 3.7 years). Of the 5575 participants in the screening group, 1417 (25.4%) had an indication for anti-osteoporosis medication. Screening and subsequent treatment had no statistically significant effect on the primary outcome fracture (hazard ratio [HR] = 0.97; 95% confidence interval [CI] 0.87-1.08), nor on the secondary outcomes osteoporotic fractures (HR = 0.91; 95% CI 0.81-1.03), major osteoporotic fractures (HR = 0.91; 95% CI 0.80-1.04), hip fractures (HR = 0.91; 95% CI 0.71-1.15), falls (odds ratio [OR] = 0.91; 95% CI 0.72-1.15), or mortality (HR = 1.03; 95% CI 0.91-1.17). Post hoc explorative finding suggested that screening might be most effective after a recent fracture (HR = 0.65; 95% CI 0.44-0.96 for major osteoporotic fractures and HR = 0.38; 95% CI 0.18-0.79 for hip fractures). The results of this study might have been compromised by nonparticipation and medication nonadherence in the screening group. Overall, this study does not provide sufficient indications to consider screening for fracture prevention. However, we cannot exclude its clinical relevance to reduce (major) osteoporotic fractures and hip fractures because of the relatively small number of women with a treatment indication in the intervention group. © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.

Keywords: CLINICAL TRIALS; FRACTURE PREVENTION; FRACTURE RISK ASSESSMENT; SCREENING.

© 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.

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Flow chart of the SALT…

Flow chart of the SALT Osteoporosis Study.

Flow chart of the SALT Osteoporosis Study.

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

  McCloskey E, Johansson H, Harvey NC, Shepstone L, Lenaghan E, Fordham R, Harvey I, Howe A, Cooper C, Clarke S, Gittoes N, Heawood A, Holland R, Marshall T, O'Neill TW, Peters TJ, Redmond N, Torgerson D, Kanis JA; SCOOP Study Team. McCloskey E, et al. J Bone Miner Res. 2018 Jun;33(6):1020-1026. doi: 10.1002/jbmr.3411. Epub 2018 Mar 23. J Bone Miner Res. 2018. PMID: 29480960 Free PMC article.

• Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial.

  Shepstone L, Lenaghan E, Cooper C, Clarke S, Fong-Soe-Khioe R, Fordham R, Gittoes N, Harvey I, Harvey N, Heawood A, Holland R, Howe A, Kanis J, Marshall T, O'Neill T, Peters T, Redmond N, Torgerson D, Turner D, McCloskey E; SCOOP Study Team. Shepstone L, et al. Lancet. 2018 Feb 24;391(10122):741-747. doi: 10.1016/S0140-6736(17)32640-5. Epub 2017 Dec 16. Lancet. 2018. PMID: 29254858 Clinical Trial.

• FRAX: re-adjust or re-think.

  El Miedany Y. El Miedany Y. Arch Osteoporos. 2020 Sep 28;15(1):150. doi: 10.1007/s11657-020-00827-z. Arch Osteoporos. 2020. PMID: 32989561 Free PMC article. Review.

• Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group.

  Chotiyarnwong P, McCloskey EV, Harvey NC, Lorentzon M, Prieto-Alhambra D, Abrahamsen B, Adachi JD, Borgström F, Bruyere O, Carey JJ, Clark P, Cooper C, Curtis EM, Dennison E, Diaz-Curiel M, Dimai HP, Grigorie D, Hiligsmann M, Khashayar P, Lewiecki EM, Lips P, Lorenc RS, Ortolani S, Papaioannou A, Silverman S, Sosa M, Szulc P, Ward KA, Yoshimura N, Kanis JA. Chotiyarnwong P, et al. Arch Osteoporos. 2022 Jun 28;17(1):87. doi: 10.1007/s11657-022-01117-6. Arch Osteoporos. 2022. PMID: 35763133 Free PMC article.

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