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Systematic screening using FRAX® leads to increased use of, and adherence to, anti-osteoporosis medications: an analysis of the UK SCOOP trial

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Abstract

Summary

In the large community-based SCOOP trial, systematic fracture risk screening using FRAX® led to greater use of AOM and greater adherence, in women at high fracture risk, compared with usual care.

Introduction

In the SCreening of Older wOmen for Prevention of fracture (SCOOP) trial, we investigated the effect of the screening intervention on subsequent long-term self-reported adherence to anti-osteoporosis medications (AOM).

Methods

SCOOP was a primary care–based UK multicentre trial of screening for fracture risk. A total of 12,483 women (70–85 years) were randomised to either usual NHS care, or assessment using the FRAX® tool ± dual-energy X-ray absorptiometry (DXA), with medication recommended for those found to be at high risk of hip fracture. Self-reported AOM use was obtained by postal questionnaires at 6, 12, 24, 36, 48 and 60 months. Analysis was limited to those who initiated AOM during follow-up. Logistic regression was used to explore baseline determinants of adherence (good ≥ 80%; poor < 80%).

Results

The mean (SD) age of participants was 75.6 (4.2) years, with 6233 randomised to screening and 6250 to the control group. Of those participants identified at high fracture risk in the screening group, 38.2% of those on treatment at 6 months were still treated at 60 months, whereas the corresponding figure for the control group was 21.6%. Older age was associated with poorer adherence (OR per year increase in age 0.96 [95% CI 0.93, 0.99], p = 0.01), whereas history of parental hip fracture was associated with greater rate adherence (OR 1.67 [95% CI 1.23, 2.26], p < 0.01).

Conclusions

Systematic fracture risk screening using FRAX® leads to greater use of AOM and greater adherence, in women at high fracture risk, compared with usual care.

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Acknowledgements

The SCOOP study was designed and done with substantial input from the Norwich Clinical Trials Unit, UK, particularly the construction of the study database and provision of online randomisation (completed by Tony Dyer). We thank Margaret McWilliams and Ann Pulford, the study’s public and patient involvement representatives, for invaluable advice and support, and our trial steering committee and data monitoring committee.

Birmingham: Nicola Crabtree, Helen Duffy, Jim Parle, Farzana Rashid, Katie Stant. Bristol: Kate Taylor, Clare Thomas (née Emmett). Manchester: Emma Knox, Cherry Tenneson, Helen Williams. Norwich: David Adams, Veronica Bion, Jeanette Blacklock, Tony Dyer. Sheffield: Selina Bratherton (née Simpson), Matt Fidler, Katharine Knight, Carol McGurk, Katie Smith, Stacey Young. Southampton: Karen Collins, Janet Cushnaghan. York: Catherine Arundel, Kerry Bell, Laura Clark, Sue Collins, Sarah Gardner, Natasha Mitchell.

Funding

This study was jointly funded by Arthritis Research UK (formerly the Arthritis Research Campaign) and the UK Medical Research Council. NMR’s time is supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at the University Hospitals Bristol NHS Foundation Trust.

Author information

Authors and Affiliations

  1. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK

    C.M. Parsons, N. Harvey & C. Cooper

  2. NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK

    N. Harvey & C. Cooper

  3. University of East Anglia, Norwich, UK

    L. Shepstone, E. Lenaghan, R. Fordham, I. Harvey, R. Holland, A. Howe & T. Marshall

  4. Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK

    J.A. Kanis & E. McCloskey

  5. Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia

    J.A. Kanis

  6. Bristol Medical School, University of Bristol, Bristol, UK

    S. Clarke, N.M. Redmond & T.J. Peters

  7. Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, Birmingham, UK

    N. Gittoes

  8. NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK

    N.M. Redmond

  9. University of York, York, UK

    D. Torgerson

  10. Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK

    T.W. O’Neill

  11. NIHR Manchester Biomedical Research Centre, Manchester University Hospitals Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK

    T.W. O’Neill

  12. Mellanby Centre for Bone Research, Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK

    E. McCloskey

  13. Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK

    E. McCloskey

  14. NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK

    C. Cooper

Authors
  1. C.M. Parsons
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  2. N. Harvey
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Consortia

the SCOOP Trial Group

  • N. Crabtree
  • , H. Duffy
  • , J. Parle
  • , F. Rashid
  • , K. Stant
  • , K. Taylor
  • , C. Thomas
  • , E. Knox
  • , C. Tenneson
  • , H. Williams
  • , D. Adams
  • , V. Bion
  • , J. Blacklock
  • , T. Dyer
  • , S. Bratherton
  • , M. Fidler
  • , K. Knight
  • , C. McGurk
  • , K. Smith
  • , S. Young
  • , K. Collins
  • , J. Cushnaghan
  • , C. Arundel
  • , K. Bell
  • , L. Clark
  • , S. Collins
  • , S. Gardner
  •  & N. Mitchell

Corresponding author

Correspondence to C. Cooper.

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Conflicts of interest

CC has received consultancy fees and honoraria from Amgen, Danone, Eli Lilly, GlaxoSmithKline, Medtronic, Merck, Nestlé, Novartis, Pfizer, Roche, Servier, Shire, Takeda and UCB. NH has received consultancy, lecture fees and honoraria from Alliance for Better Bone Health, Amgen, MSD, Eli Lilly, Servier, Shire, UCB, Consilient Healthcare and Internis Pharma. JK has held grants from Amgen, Lilly, Unigene and Radius Health; has received non-financial support from Medimaps, Asahi and AgNovos; and is the architect of FRAX®, but has no financial interest. EM has been, or currently is, an adviser or speaker for and has received research support from ActiveSignal, Amgen, AstraZeneca, Consilient Healthcare, GlaxoSmithKline, Hologic, Internis, Eli Lilly, Medtronic, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis, Servier, Synexus, Tethys, UCB and Warner Chilcott; and has received research support from I3 Innovus, International Osteoporosis Foundation and Unilever. All other authors declare no competing interests.

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C. Parsons and N. Harvey are joint first authors.

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Parsons, C., Harvey, N., Shepstone, L. et al. Systematic screening using FRAX® leads to increased use of, and adherence to, anti-osteoporosis medications: an analysis of the UK SCOOP trial. Osteoporos Int 31, 67–75 (2020). https://doi.org/10.1007/s00198-019-05142-z

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