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Non-participation in systematic screening for osteoporosis—the ROSE trial

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Abstract

Summary

Population-based screening for osteoporosis is still controversial and has not been implemented. Non-participation in systematic screening was evaluated in 34,229 women age 65–81 years. Although participation rate was high, non-participation was associated with comorbidity, aging other risk factors for fractures, and markers of low social status, e.g., low income, pension, and living alone. A range of strategies is needed to increase participation, including development of targeted information and further research to better understand the barriers and enablers in screening for osteoporosis.

Introduction

Participation is crucial to the success of a screening program. The objective of this study was to analyze non-participation in Risk-stratified Osteoporosis Strategy Evaluation, a two-step population-based screening program for osteoporosis.

Methods

Thirty-four thousand two hundred twenty-nine women aged 65 to 81 years were randomly selected from the background population and randomized to either a screening group (intervention) or a control group. All women received a self-administered questionnaire designed to allow calculation of future risk of fracture based on FRAX. In the intervention group, women with an estimated high risk of future fracture were invited to DXA scanning. Information on individual socioeconomic status and comorbidity was obtained from national registers.

Results

A completed questionnaire was returned by 20,905 (61%) women. Non-completion was associated with older age, living alone, lower education, lower income, and higher comorbidity. In the intervention group, ticking “not interested in DXA” in the questionnaire was associated with older age, living alone, and low self-perceived fracture risk. Women with previous fracture or history of parental hip fracture were more likely to accept screening by DXA. Dropping out when offered DXA, was associated with older age, current smoking, higher alcohol consumption, and physical impairment.

Conclusions

Barriers to population-based screening for osteoporosis appear to be both psychosocial and physical in nature. Women who decline are older, have lower self-perceived fracture risk, and more often live alone compared to women who accept the program. Dropping out after primary acceptance is associated not only with aging and physical impairment but also with current smoking and alcohol consumption. Measures to increase program participation could include targeted information and reducing physical barriers for attending screening procedures.

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Acknowledgements

Participants in the ROSE study and technical staff in the four involved hospitals: Odense University Hospital, Odense; Hospital of Funen, Nyborg; Hospital of Southwest Denmark, Esbjerg; and Sygehus Lillebælt Hospital, Kolding, Denmark, and Claire Gudex for editorial support.

Funding

The ROSE study was supported by INTERREG 4A, the region of Southern Denmark, and Odense University Hospital. The funding agencies had no direct role in the conduct of the study, data collection, analysis, and interpretation of the data or the preparation, review, and final approval of the manuscript.

Author information

Authors and Affiliations

  1. Department of Endocrinology, Odense University Hospital, Kloevervaenget 10, 6.sal, 5000, Odense C, Odense, Denmark

    M. J. Rothmann & A. P. Hermann

  2. Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    M. J. Rothmann, M. Højberg, J. Gram, K. Brixen, A. P. Hermann & K. H. Rubin

  3. Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark

    S. Möller & K. H. Rubin

  4. Department of Health Promotion and Prevention, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark

    T. Holmberg

  5. Department of Research, Hospital of Southern Norway, Kristiansand, Norway

    M. Højberg

  6. Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark

    J. Gram

  7. KORA, the Danish Institute for Local and Regional Government Research, Copenhagen, Denmark

    M. Bech

  8. Odense University Hospital, Odense, Denmark

    K. Brixen

  9. Section Biomedical Imaging, Department of Radiology and Neuroradiology, Christian-Albrechts-Universitäts zu Kiel, Kiel, Germany

    C.-C. Glüer & R. Barkmann

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  1. M. J. Rothmann
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  2. S. Möller
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  6. M. Bech
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  7. K. Brixen
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  8. A. P. Hermann
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  9. C.-C. Glüer
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  10. R. Barkmann
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  11. K. H. Rubin
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Corresponding author

Correspondence to M. J. Rothmann.

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Conflicts of interest

All authors have completed the authorship and disclosure form. S Möller, T Holmberg, M Bech, J Gram, R Barkmann, CC Glüer, and KH Rubin have no conflict of interest. MJ Rothmann has received speaker fee from Eli Lilly. M Hoiberg is full-time employee of Boehringer-Ingelheim Norway KS (currently). AP Hermann serves on advisory boards for Eli Lilly and Amgen, and she has received research funding from Eli Lilly, speaker fee from Eli Lilly, GSK, Genzyme, and Amgen, and K Brixen received funding from Merck Sharpe & Dohme, Amgen, Novartis, and NPS, all outside the submitted work.

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Rothmann, M.J., Möller, S., Holmberg, T. et al. Non-participation in systematic screening for osteoporosis—the ROSE trial. Osteoporos Int 28, 3389–3399 (2017). https://doi.org/10.1007/s00198-017-4205-y

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  • DOI: https://doi.org/10.1007/s00198-017-4205-y

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