Format

Send to

Choose Destination
Osteoporos Int. 2020 Mar;31(3):457-464. doi: 10.1007/s00198-019-05270-6. Epub 2020 Jan 20.

Screening for high hip fracture risk does not impact on falls risk: a post hoc analysis from the SCOOP study.

Author information

1
Centre for Integrated Research in Musculoskeletal Aging, University of Sheffield Medical School, Sheffield, UK.
2
Department of Oncology and Metabolism, Academic Unit of Bone Metabolism, The Mellanby Centre For Bone Research, University of Sheffield, Sheffield, UK.
3
Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
4
Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
5
Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
6
Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
7
Norwich Medical School, University of East Anglia, Norwich, UK.
8
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
9
NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
10
Oxford Biomedical Research Unit, University of Oxford, Oxford, UK.
11
Department of Rheumatology, University Hospitals Bristol, Bristol, UK.
12
Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, Birmingham, UK.
13
Bristol Medical School, University of Bristol, Bristol, UK.
14
Leicester Medical School, Centre for Medicine, University of Leicester, Leicester, UK.
15
Norfolk and Norwich University Hospital, Norwich, UK.
16
NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
17
Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK.
18
National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation, Bristol, UK.
19
Department of Health Sciences, University of York, York, UK.
20
Centre for Integrated Research in Musculoskeletal Aging, University of Sheffield Medical School, Sheffield, UK. e.v.mccloskey@sheffield.ac.uk.
21
Department of Oncology and Metabolism, Academic Unit of Bone Metabolism, The Mellanby Centre For Bone Research, University of Sheffield, Sheffield, UK. e.v.mccloskey@sheffield.ac.uk.
22
Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK. e.v.mccloskey@sheffield.ac.uk.

Abstract

A reduction in hip fracture incidence following population screening might reflect the effectiveness of anti-osteoporosis therapy, behaviour change to reduce falls, or both. This post hoc analysis demonstrates that identifying high hip fracture risk by FRAX was not associated with any alteration in falls risk.

INTRODUCTION:

To investigate whether effectiveness of an osteoporosis screening programme to reduce hip fractures was mediated by modification of falls risk in the screening arm.

METHODS:

The SCOOP study recruited 12,483 women aged 70-85 years, individually randomised to a control (n = 6250) or screening (n = 6233) arm; in the latter, osteoporosis treatment was recommended to women at high risk of hip fracture, while the control arm received usual care. Falls were captured by self-reported questionnaire. We determined the influence of baseline risk factors on future falls, and then examined for differences in falls risk between the randomisation groups, particularly in those at high fracture risk.

RESULTS:

Women sustaining one or more falls were slightly older at baseline than those remaining falls free during follow-up (mean difference 0.70 years, 95%CI 0.55-0.85, p < 0.001). A higher FRAX 10-year probability of hip fracture was associated with increased likelihood of falling, with fall risk increasing by 1-2% for every 1% increase in hip fracture probability. However, falls risk factors were well balanced between the study arms and, importantly, there was no evidence of a difference in falls occurrence. In particular, there was no evidence of interaction (p = 0.18) between baseline FRAX hip fracture probabilities and falls risk in the two arms, consistent with no impact of screening on falls in women informed to be at high risk of hip fracture.

CONCLUSION:

Effectiveness of screening for high FRAX hip fracture probability to reduce hip fracture risk was not mediated by a reduction in falls.

KEYWORDS:

FRAX; Falls; Fractures; Older women; Osteoporosis; Screening

PMID:
31960099
DOI:
10.1007/s00198-019-05270-6

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center