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Title: Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial
Authors: Shepstone, Lee
Lenaghan, Elizabeth
Cooper, Cyrus
Clarke, Shane
Fong-Soe-Khioe, Rebekah
Fordham, Richard
Gittoes, Neil
Harvey, Ian
Harvey, Nick
Heawood, Alison
Holland, Richard
Howe, Amanda
Kanis, John
Marshall, Tarnya
O'Neill, Terence
Peters, Tim
Redmond, Niamh
Torgerson, David
Turner, David
McCloskey, Eugene
The SCOOP Study Team
First Published: 15-Dec-2017
Publisher: Elsevier
Citation: Lancet, 2018, 391(10122), pg. 741-747.
Abstract: Background- Despite effective assessment tools and medications targeting osteoporosis and related fractures, screening for fracture risk is not currently advocated in the UK. We tested whether a community based screening intervention could reduce fractures in older women. Methods- We conducted a two-arm randomised controlled trial in women aged 70 to 85 years comparing a screening programme using the FRAX risk assessment tool versus usual management. The primary outcome was the proportion of individuals experiencing one or more osteoporosis-related fractures over a five-year period. In the screening arm, treatment was recommended in women identified to be at high risk of hip fracture, according to the FRAX 10-year hip fracture probability. Findings- 12 483 eligible women, identified from primary care, participated in the trial. Of 6 233 randomised to screening, treatment was recommended in 898 (14·4%). Osteoporosis medication use was higher at the end of year one in the screening group compared to controls (15·3% vs 4·5%, respectively), with uptake particularly higher (78.3% at 6 months) in the screening high risk subgroup. Screening did not reduce the incidence of all osteoporosis-related fractures (hazard ratio: 0·94, p=0·178, 95% C.I. : 0·85 to 1·03) but there was strong evidence for a reduction in hip fractures, a pre-specified secondary outcome (hazard ratio : 0·72, p=0·002 95% C.I. : 0·59 to 0·89). There was no evidence of differences in mortality, anxiety levels or quality of life. Interpretation- A systematic, community-based screening programme of fracture risk in older women in the UK is feasible. Whilst there was no reduction in overall fracture rate the intervention was effective in reducing hip fractures by an estimated 28%. Funding- The Arthritis Research United Kingdom (ARUK), formerly the Arthritis Research Campaign (ARC), and the Medical Research Council (MRC) of the UK jointly funded this trial.
DOI Link: 10.1016/S0140-6736(17)32640-5
ISSN: 0140-6736
eISSN: 1474-547X
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Appears in Collections:Published Articles, College of Medicine, Biological Sciences and Psychology

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