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

Screening for high hip fracture risk does not impact on falls risk: a post hoc analysis from the SCOOP study
Screening for high hip fracture risk does not impact on falls risk: a post hoc analysis from the SCOOP study
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.IntroductionTo investigate whether effectiveness of an osteoporosis screening programme to reduce hip fractures was mediated by modification of falls risk in the screening arm.MethodsThe 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.ResultsWomen 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.ConclusionEffectiveness of screening for high FRAX hip fracture probability to reduce hip fracture risk was not mediated by a reduction in falls.
FRAX, Falls, Fractures, Older women, Osteoporosis, Screening
0937-941X
457-464
Condurache, C.
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Chiu, S.
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Chotiyamwong, P.
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Johansson, Helena
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Shepstone, L.
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Lenaghan, E.
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Cooper, C.
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Clarke, S.
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Khioe, R.F.S.
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Fordham, R.
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Gittoes, N.
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Harvey, I.
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Harvey, N.
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Heawood, A.
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Holland, R.
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Howe, A.
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Kanis, J. A.
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Marshall, T.
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O'Neill, T.W.
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Peters, T.J.
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Redmond, N.M.
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Torgerson, D.
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Turner, D.
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McCloskey, E. V.
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Condurache, C.
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Chiu, S.
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Chotiyamwong, P.
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Johansson, Helena
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Shepstone, L.
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Lenaghan, E.
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Cooper, C.
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Clarke, S.
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Khioe, R.F.S.
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Fordham, R.
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Gittoes, N.
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Harvey, I.
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Harvey, N.
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Heawood, A.
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Holland, R.
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Howe, A.
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Kanis, J. A.
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Marshall, T.
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O'Neill, T.W.
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Peters, T.J.
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Redmond, N.M.
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Torgerson, D.
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Turner, D.
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McCloskey, E. V.
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Condurache, C., Chiu, S., Chotiyamwong, P., Johansson, Helena, Shepstone, L., Lenaghan, E., Cooper, C., Clarke, S., Khioe, R.F.S., Fordham, R., Gittoes, N., Harvey, I., Harvey, N., Heawood, A., Holland, R., Howe, A., Kanis, J. A., Marshall, T., O'Neill, T.W., Peters, T.J., Redmond, N.M., Torgerson, D., Turner, D. and McCloskey, E. V. (2020) Screening for high hip fracture risk does not impact on falls risk: a post hoc analysis from the SCOOP study. Osteoporosis International, 31 (3), 457-464. (doi:10.1007/s00198-019-05270-6).

Record type: Article

Abstract

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.IntroductionTo investigate whether effectiveness of an osteoporosis screening programme to reduce hip fractures was mediated by modification of falls risk in the screening arm.MethodsThe 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.ResultsWomen 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.ConclusionEffectiveness 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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More information

Accepted/In Press date: 17 December 2019
e-pub ahead of print date: 20 January 2020
Published date: March 2020
Keywords: FRAX, Falls, Fractures, Older women, Osteoporosis, Screening

Identifiers

Local EPrints ID: 439775
URI: http://eprints.soton.ac.uk/id/eprint/439775
ISSN: 0937-941X
PURE UUID: 5f29d6fb-8a49-4eea-85b1-af115fb956b4
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for N. Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 01 May 2020 16:40
Last modified: 26 Nov 2021 02:48

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Contributors

Author: C. Condurache
Author: S. Chiu
Author: P. Chotiyamwong
Author: Helena Johansson
Author: L. Shepstone
Author: E. Lenaghan
Author: C. Cooper ORCID iD
Author: S. Clarke
Author: R.F.S. Khioe
Author: R. Fordham
Author: N. Gittoes
Author: I. Harvey
Author: N. Harvey ORCID iD
Author: A. Heawood
Author: R. Holland
Author: A. Howe
Author: J. A. Kanis
Author: T. Marshall
Author: T.W. O'Neill
Author: T.J. Peters
Author: N.M. Redmond
Author: D. Torgerson
Author: D. Turner
Author: E. V. McCloskey

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