Management of Patients With High Baseline Hip Fracture Risk by FRAX Reduces Hip Fractures—A Post Hoc Analysis of the SCOOP Study |
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| Authors: | Eugene McCloskey Helena Johansson Nicholas C Harvey Lee Shepstone Elizabeth Lenaghan Ric Fordham Ian Harvey Amanda Howe Cyrus Cooper Shane Clarke Neil Gittoes Alison Heawood Richard Holland Tarnya Marshall Terence W O'Neill Tim J Peters Niamh Redmond David Torgerson John A Kanis the SCOOP Study Team |
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| Affiliation: | 1. Mellanby Centre for Bone Research, Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, and Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK;2. Australian Catholic University, Melbourne, Australia;3. MRC Lifecourse Epidemiology Unit and NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton, and University Hospital Southampton NHS Foundation Trust, Southampton, UK;4. Norwich Medical School, University of East Anglia, Norwich, UK;5. NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK;6. Department of Rheumatology, University Hospitals Bristol, Bristol, UK;7. Centre for Endocrinology, Diabetes, and Metabolism, Queen Elizabeth Hospital, Birmingham, UK;8. Bristol Medical School, University of Bristol, Bristol, UK;9. Leicester Medical School, Centre for Medicine, University of Leicester, Leicester, UK;10. Norfolk and Norwich University Hospital, Norwich, UK;11. Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK;12. Department of Health Sciences, University of York, York, UK;13. Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK, and Australian Catholic University, Melbourne, Australia |
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| Abstract: | 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. © 2018 American Society for Bone and Mineral Research. |
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| Keywords: | HIP FRACTURE RISK OSTEOPOROSIS FRAX |
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