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

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Abstract

Summary

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.

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References

  1. Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136

    Article  CAS  Google Scholar 

  2. Cummings SR, Nevitt MC (1989) A hypothesis: the causes of hip fractures. J Gerontol 44:M107–M111

    Article  CAS  Google Scholar 

  3. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev Issue 9. Art. No.: CD007146. https://doi.org/10.1002/14651858.CD007146.pub3

  4. Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL (2018) Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 319:1705–1716

    Article  Google Scholar 

  5. Black DM, Cummings SR, Karpf DB et al (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541

    Article  CAS  Google Scholar 

  6. McClung MR, Geusens P, Miller PD, Zippel H, Bensen WG, Roux C, Adami S, Fogelman I, Diamond T, Eastell R, Meunier PJ, Reginster JY, Hip Intervention Program Study Group (2001) Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 344:333–340

    Article  CAS  Google Scholar 

  7. Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR, HORIZON Pivotal Fracture Trial (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356:1809–1822

    Article  CAS  Google Scholar 

  8. Shepstone L, Lenaghan E, Cooper C, Clarke S, Fong-Soe-Khioe R, Fordham R, Gittoes N, Harvey I, Harvey N, Heawood A, Holland R, Howe A, Kanis J, Marshall T, O'Neill T, Peters T, Redmond N, Torgerson D, Turner D, McCloskey E, SCOOP Study Team (2018) Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial. Lancet 391:741–747

    Article  Google Scholar 

  9. McCloskey E, Johansson H, Harvey NC, Shepstone L, Lenaghan E, Fordham R, Harvey I, Howe A, Cooper C, Clarke S, Gittoes N, Heawood A, Holland R, Marshall T, O'Neill TW, Peters TJ, Redmond N, Torgerson D, Kanis JA, SCOOP Study Team (2018) Management of patients with high baseline hip fracture risk by FRAX reduces hip fractures-a post hoc analysis of the SCOOP study. J Bone Miner Res 33:1020–1026

    Article  CAS  Google Scholar 

  10. Deutekom M, Vansenne F, McCaffery K, Essink-Bot ML, Stronks K, Bossuyt PM (2011) The effects of screening on health behaviour: a summary of the results of randomized controlled trials. J Public Health (Oxf) 33:71–79

    Article  Google Scholar 

  11. van der Aalst CM, van Klaveren RJ, de Koning HJ (2010) Does participation to screening unintentionally influence lifestyle behaviour and thus lifestyle-related morbidity? Best Pract Res Clin Gastroenterol 24:465–478

    Article  Google Scholar 

  12. Bankhead CR, Brett J, Bukach C, Webster P, Stewart-Brown S, Munafo M, Austoker J (2003) The impact of screening on future health-promoting behaviours and health beliefs: a systematic review. Health Technol Assess 7:1–92

    Article  CAS  Google Scholar 

  13. Larsen IK, Grotmol T, Almendingen K, Hoff G (2007) Impact of colorectal cancer screening on future lifestyle choices: a three-year randomized controlled trial. Clin Gastroenterol Hepatol 5:477–483

    Article  Google Scholar 

  14. Shepstone L, Fordham R, Lenaghan E, Harvey I, Cooper C, Gittoes N, Heawood A, Peters T, O'Neill T, Torgerson D, Holland R, Howe A, Marshall T, Kanis J, McCloskey E (2012) A pragmatic randomised controlled trial of the effectiveness and cost-effectiveness of screening older women for the prevention of fractures: rationale, design and methods for the SCOOP study. Osteoporos Int 23:2507–2515

    Article  CAS  Google Scholar 

  15. Lamb SE, Jorstad-Stein EC, Hauer K, Becker C, Prevention of Falls Network E, Outcomes Consensus G (2005) Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. J Am Geriatr Soc 53:1618–1622

    Article  Google Scholar 

  16. Kalbfleisch JD, Prentice RL (1980) Statistical analysis of failure time data. John Wiley & Sons, Inc., New York

  17. Callis N (2016) Falls prevention: identification of predictive fall risk factors. Appl Nurs Res 29:53–58

    Article  Google Scholar 

  18. Ambrose AF, Paul G, Hausdorff JM (2013) Risk factors for falls among older adults: a review of the literature. Maturitas 75:51–61

    Article  Google Scholar 

  19. Al-Aama T (2011) Falls in the elderly: spectrum and prevention. Can Fam Physician 57:771–776

    PubMed  PubMed Central  Google Scholar 

  20. Geusens P, Milisen K, Dejaeger E, Boonen S (2003) Falls and fractures in postmenopausal women: a review. J Br Menopause Soc 9:101–106

    PubMed  Google Scholar 

  21. Stenhagen M, Ekström H, Nordell E, Elmståhl S (2013) Falls in the general elderly population: a 3- and 6- year prospective study of risk factors using data from the longitudinal population study 'Good ageing in Skane'. BMC Geriatr 13:81

    Article  Google Scholar 

  22. Kojima G, Kendrick D, Skelton DA, Morris RW, Gawler S, Iliffe S (2015) Frailty predicts short-term incidence of future falls among British community-dwelling older people: a prospective cohort study nested within a randomised controlled trial. BMC Geriatr 15:155

    Article  Google Scholar 

  23. Kwan MM, Close JC, Wong AK, Lord SR (2011) Falls incidence, risk factors, and consequences in Chinese older people: a systematic review. J Am Geriatr Soc 59:536–543

    Article  Google Scholar 

  24. Mänty M, Heinonen A, Viljanen A, Pajala S, Koskenvuo M, Kaprio J, Rantanen T (2010) Self-reported preclinical mobility limitation and fall history as predictors of future falls in older women: prospective cohort study. Osteoporos Int 21:689–693

    Article  Google Scholar 

  25. Baccaro LF, Machado VS, Costa-Paiva L, Sousa MH, Osis MJ, Pinto-Neto AM (2013) Treatment for menopausal symptoms and having health insurance were associated with a lower prevalence of falls among Brazilian women. Maturitas 75:367–372

    Article  Google Scholar 

  26. Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E (2010) Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology 21:658–668

    Article  Google Scholar 

  27. Harvey NC, Johansson H, Oden A et al (2016) FRAX predicts incident falls in elderly men: findings from MrOs Sweden. Osteoporos Int 27:267–274

    Article  CAS  Google Scholar 

  28. Harvey NC, Oden A, Orwoll E et al (2018) Falls predict fractures independently of FRAX probability: a meta-analysis of the Osteoporotic Fractures in Men (MrOS) Study. J Bone Miner Res 33:510–516

    Article  Google Scholar 

  29. Nilsson M, Eriksson J, Larsson B, Oden A, Johansson H, Lorentzon M (2016) Fall risk assessment predicts fall-related injury, hip fracture, and head injury in older adults. J Am Geriatr Soc 64:2242–2250

    Article  Google Scholar 

  30. Edwards MH, Jameson K, Denison H, Harvey NC, Sayer AA, Dennison EM, Cooper C (2013) Clinical risk factors, bone density and fall history in the prediction of incident fracture among men and women. Bone 52:541–547

    Article  CAS  Google Scholar 

  31. Hippisley-Cox J, Coupland C (2009) Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractureScores. Bmj 339:b4229

    Article  Google Scholar 

  32. Nguyen ND, Pongchaiyakul C, Center JR, Eisman JA, Nguyen TV (2005) Identification of high-risk individuals for hip fracture: a 14-year prospective study. J Bone Miner Res 20:1921–1928

    Article  Google Scholar 

  33. Black DM, Thompson DE, Bauer DC, Ensrud K, Musliner T, Hochberg MC, Nevitt MC, Suryawanshi S, Cummings SR (2000) Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. FIT Research Group. J Clin Endocrinol Metab 85:4118–4124

    Article  CAS  Google Scholar 

  34. Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, Delmas P, Zoog HB, Austin M, Wang A, Kutilek S, Adami S, Zanchetta J, Libanati C, Siddhanti S, Christiansen C, FREEDOM Trial (2009) Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 361:756–765

    Article  CAS  Google Scholar 

  35. Rubin KH, Rothmann MJ, Holmberg T, Høiberg M, Möller S, Barkmann R, Glüer CC, Hermann AP, Bech M, Gram J, Brixen K (2018) Effectiveness of a two-step population-based osteoporosis screening program using FRAX: the randomized Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study. Osteoporos Int 29:567–578

    Article  CAS  Google Scholar 

  36. Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. Bmj 312:1254–1259

    Article  CAS  Google Scholar 

  37. El-Khoury F, Cassou B, Charles MA, Dargent-Molina P (2013) The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ 347:f6234

    PubMed  PubMed Central  Google Scholar 

  38. Frick KD, Kung JY, Parrish JM, Narrett MJ (2010) Evaluating the cost-effectiveness of fall prevention programs that reduce fall-related hip fractures in older adults. J Am Geriatr Soc 58:136–141

    Article  Google Scholar 

  39. Turner DA, Khioe RFS, Shepstone L, Lenaghan E, Cooper C, Gittoes N, Harvey NC, Holland R, Howe A, McCloskey E, O'Neill TW, Torgerson D, Fordham R, SCOOP Study Team (2018) The cost-effectiveness of screening in the community to reduce osteoporotic fractures in older women in the UK: economic evaluation of the SCOOP study. J Bone Miner Res 33:845–851

    Article  Google Scholar 

  40. Jarvinen TL, Michaelsson K, Jokihaara J et al (2015) Overdiagnosis of bone fragility in the quest to prevent hip fracture. BMJ 350:h2088

    Article  Google Scholar 

  41. Compston J (2015) Overdiagnosis of osteoporosis: fact or fallacy? Osteoporos Int 26:2051–2054

    Article  CAS  Google Scholar 

  42. Mackenzie L, Byles J, D'Este C (2006) Validation of self-reported fall events in intervention studies. Clin Rehabil 20:331–339

    Article  Google Scholar 

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Acknowledgments

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. We also thank Ms. Wachirapan Narktang of the Division of Research, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital for her assistance with artwork and illustration of the figure.

Other SCOOP Study team members are as follows: 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 Versus Arthritis (formerly Arthritis Research UK) and the UK Medical Research Council. NMR’s time is financially supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust.

Author information

Authors and Affiliations

  1. Centre for Integrated Research in Musculoskeletal Aging, University of Sheffield Medical School, Sheffield, UK

    C. I. Condurache, S. Chiu & E. McCloskey

  2. Department of Oncology and Metabolism, Academic Unit of Bone Metabolism, The Mellanby Centre For Bone Research, University of Sheffield, Sheffield, UK

    C. I. Condurache, S. Chiu, P. Chotiyarnwong & E. McCloskey

  3. Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

    P. Chotiyarnwong

  4. Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK

    H. Johansson, J. A. Kanis & E. McCloskey

  5. Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    H. Johansson

  6. Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia

    H. Johansson & J. A. Kanis

  7. Norwich Medical School, University of East Anglia, Norwich, UK

    L. Shepstone, E. Lenaghan, R. F. S. Khioe, R. Fordham, I. Harvey, A. Howe & D. Turner

  8. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

    C. Cooper & N. C. Harvey

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

    C. Cooper & N. C. Harvey

  10. Oxford Biomedical Research Unit, University of Oxford, Oxford, UK

    C. Cooper

  11. Department of Rheumatology, University Hospitals Bristol, Bristol, UK

    S. Clarke

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

    N. Gittoes

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

    A. Heawood, T. J. Peters & N. M. Redmond

  14. Leicester Medical School, Centre for Medicine, University of Leicester, Leicester, UK

    R. Holland

  15. Norfolk and Norwich University Hospital, Norwich, UK

    T. Marshall

  16. NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK

    T. W. O’Neill

  17. Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK

    T. W. O’Neill

  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

    N. M. Redmond

  19. Department of Health Sciences, University of York, York, UK

    D. Torgerson

Authors
  1. C. I. Condurache
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  2. S. Chiu
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  3. P. Chotiyarnwong
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  4. H. Johansson
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  5. L. Shepstone
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  6. E. Lenaghan
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  7. C. Cooper
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  8. S. Clarke
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  9. R. F. S. Khioe
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  10. R. Fordham
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  11. N. Gittoes
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  12. I. Harvey
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  13. N. C. Harvey
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  14. A. Heawood
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  15. R. Holland
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  16. A. Howe
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  17. J. A. Kanis
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  18. T. Marshall
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  19. T. W. O’Neill
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  20. T. J. Peters
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  21. N. M. Redmond
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  22. D. Torgerson
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  23. D. Turner
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  24. E. McCloskey
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Consortia

the SCOOP Study Team

  • 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 E. McCloskey.

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Condurache, C.I., Chiu, S., Chotiyarnwong, P. et al. Screening for high hip fracture risk does not impact on falls risk: a post hoc analysis from the SCOOP study. Osteoporos Int 31, 457–464 (2020). https://doi.org/10.1007/s00198-019-05270-6

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  • DOI: https://doi.org/10.1007/s00198-019-05270-6

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