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

Parsons, C. M.; Harvey, N.; Shepstone, L.; Kanis, J. A.; Lenaghan, E.; Clarke, S.; Fordham, R.; Gittoes, N.; Harvey, I.; Holland, R.; Redmond, N. M.; Howe, A.; Marshall, T.; Peters, T. J.; Torgerson, D.; O’Neill, T. W.; McCloskey, E.; Cooper, C.

Affiliations

¹MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

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

³University of East Anglia, Norwich, UK

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

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

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

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

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

⁹University of York, York, UK

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

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

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

¹³Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK

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

Abstract and keywords

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.

Keywords: Adherence; Epidemiology; FRAX®\n; Medication; Osteoporosis; Screening

Links

DOI: 10.1007/s00198-019-05142-z

PubMed: 31606826

WoS: 000490057600001

History

Received: 2019-04-16

Accepted: 2019-08-20

Online: 2019-10-12

Cited Works (6)

Year	Entry
2017	Compston J, Cooper A, Cooper C, Gittoes N, Gregson C, Harvey N, Hope S, Kanis JA, McCloskey EV, Poole KES, Reid DM, Selby P, Thompson F, Thurston A, Vine N; The National Osteoporosis Guideline Group (NOGG). UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. December 2017;12(1):1-24.
2016	Kanis JA, Harvey NC, Cooper C, Johansson H, Odén A, McCloskey EV; The Advisory Board of the National Osteoporosis Guideline Group. A systematic review of intervention thresholds based on FRAX: a report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation. Arch Osteoporos. December 2016;11(1):25.
2013	Svedbom A, Hernlund E, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA. Osteoporosis in the European Union: medical management, epidemiology and economic burden. Arch Osteoporos. December 2013;8(1):136.
2015	Jha S, Wang Z, Laucis N, Bhattacharyya T. Trends in media reports, oral bisphosphonate prescriptions, and hip fractures 1996–2012: an ecological analysis. J Bone Miner Res. December 2015;30(12):2179-2187.
2017	Harvey NCW, McCloskey EV, Mitchell PJ, Dawson-Hughes B, Pierroz DD, Reginster J-Y, Rizzoli R, Cooper C, Kanis JA. Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures. Osteoporos Int. May 2017;28(5):1507-1529.
2014	Kanis JA, Svedbom A, Harvey N, McCloskey EV. The osteoporosis treatment gap. J Bone Miner Res. September 2014;29(9):1926-1928.

Cited By (2)

Year	Entry
2022	Ralston KAP, Hauser B, Paskins Z, Ralston SH. Effective communication and the osteoporosis care gap. J Bone Miner Res. November 2022;37(11):2049-2054.
2020	Kanis JA, Johansson H, Harvey NC, Gudnason V, Sigurdsson G, Siggeirsdottir K, Lorentzon M, Liu E, Vandenput L, McCloskey EV. Adjusting conventional FRAX estimates of fracture probability according to the recency of sentinel fractures. Osteoporos Int. October 2020;31(10):1817-1828.