Population screening for osteoporosis risk: a randomised control trial of medication use and fracture risk
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Randomised control trial of osteoporosis screening in 4,800 women aged 45–54 years was carried out. Screened group observed an increase of 7.9% in hormone replacement therapy (HRT) use (p < 0.001), 15% in other osteoporosis treatments (p < 0.001) and a 25.9% reduction in fracture risk compared with control. Screening for osteoporosis significantly increases treatment use and reduces fracture incidence.
Population screening programmes can identify menopausal women with low bone mineral density (BMD) and elevated risk of future fracture but require to be proven effective by a randomised control trial.
A total of 4,800 women, 45–54 years, were randomised in equal numbers to screening or no screening (control) groups. Following screening, those in the lowest quartile of BMD were advised to consider HRT. Nine years later, the effect of screening on the uptake of treatment and the incidence of fractures were assessed by postal questionnaire. Categorical differences were assessed using χ 2 test. Cox regression was used to assess hazard ratio (HR).
Of the screened and the control groups, 52.4% vs 44.5%, respectively, reported taking HRT (p < 0.001). In addition, 36.6% of the screened vs 21.6% of the control groups reported the use of vitamin D, calcium, alendronate, etidronate or raloxifene (p < 0.001). In a per protocol analysis of verified incident fractures, a 25.9% reduction in risk of fractures (of any site) in the screened group was observed (HR = 0.741, 95% CI = 0.551–0.998 adjusted age, weight and height).
Screening for osteoporosis as assessed by low bone density significantly increases the use of HRT and other treatments for osteoporosis and reduces fracture incidence.
KeywordsFracture Hormone replacement therapy Randomised control trial
The authors would like to thank Graeme Maclennan for his statistical advice and help calculating the adjusted treatment received estimate. DMR is grateful to the arthritis research campaign for continued infrastructure support. Grant funding pertinent to the data collection for this study was gratefully received initially from the Wolfson Foundation and subsequently from GlaxoSmithKline. Finally, we express our gratitude to all the women who gave so freely of their time to take part in this study.
Conflicts of interest
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