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

Abstract

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=6,250) or screening (n=6,233) 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.Result: 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.

The Risk of Osteoporotic Forearm Fractures in Postmenopausal Women in a Siberian Population Sample

“…This study has demonstrated that this intervention leads to a 28% reduction in hip fracture risk [16]. As would be expected from this approach, the screening appeared to be the most effective in those at highest baseline fracture risk [17], and importantly, it was shown to be cost-effective [18,19] Increased attention to OFF is important to identify women at increased risk for repeated future fractures and to apply preventive measures [20]. A high frequency of comorbidity of severe osteoporosis with NCD has been established [21].…”

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

“…While assessment of falls risk and appropriate interventions aimed at reducing falls risk has been shown to be effective, at least in the short term, their impact on the risk of hip fracture is less certain [104,107]. Furthermore, the reduction in hip fractures in the SCOOP study was not mediated by any impact of the screening programme on falls risk [167].…”

Cost-effectiveness of Screening for Osteoporosis in Older Men With a History of Falls

“…10 Fracture prevention could be achieved by screening and treatment for osteoporosis without reducing the number of falls. 60 These findings do not suggest that fall prevention measures should not be included in patient management but do raise a concern that, for individuals with significant skeletal risk factors, fall prevention measures alone might not be sufficient to reduce fallrelated fractures. On the other hand, combined with older age, the presence of osteoporosis accounts for only one-third of all fracture cases in men.…”