A randomised controlled trial (RCT) of osteoporosis screening: Long term effects on use of medication and fracture risk

Rebecca Barr, Alison Stewart, V Akula, D. J. Torgerson, David M Reid

Research output: Contribution to journalAbstract

Abstract

Osteoporosis is a common condition occurring in 1 in 2 women but current management is unsatisfactory because it is generally not introduced until a major fracture has occurred. Population screening programmes are one means to identify menopausal women with low bone mineral density (BMD) and an elevated risk of future fracture but require to be proven effective in a RCT.
In 1993 a random sample of 4800 women aged 45-54years living within 32km of Aberdeen, Scotland, was selected from the community health index. Subjects were randomised in equal numbers to screening (active) or no screening (inactive controls). Only the active women were assessed and those found to be in the lowest quartile of BMD were suggested to consider HRT treatment and informed about other lifestyle factors to reduce fracture risk. Nine years after randomisation a follow-up questionnaire was mailed to both groups to assess the
effect of screening on the uptake of treatment and on the incidence of fractures.
Response rates after 9 years were 56.8% in the control group and 59.7% in the active group. No significant differences were observed in age, weight, height or self-reported general health, nor in self-reported disease states with the exception of hyperparathyroidism (controls 0.5%, actives 1.1%, p=0.05). 52.4% of the active group reported taking HRT compared with 44.5% of the control group <0.001). Similarly the active subjects were significantly more likely to report current or past use of vitamin D, calcium, alendronate, etidronate or raloxifene than the control subjects (36.6% of the active group and 21.6% of the control group reporting to have taken some form of osteoporosis medication(p<0.001)). In a per protocol analysis of self-reported incident fractures a 23.7% reduction in fractures (of any site) in the active group was observed (RR=0.763 95%CI=0.579-1.006) which increased to 25.2% following adjustment for age, weight and height (RR =0.748, 95%CI=0.567-0.986).
No significant difference was observed in the number of fallers (controls=13.9% vs actives=15.6%, p=0.202) or the rate of falls (controls=0.28falls/year vs actives=0.30falls/year, p=0.503).
Screening for low bone density significantly increases the use of HRT and other treatment for osteoporosis and reduces fracture incidence.
Original languageEnglish
Article numberOC19
Pages (from-to)1295-1295
Number of pages1
JournalJournal of Bone and Mineral Research
Volume20
Issue number7
Publication statusPublished - Jul 2005
EventAnnual Meeting of the Bone and Tooth Society - Birmingham, United Kingdom
Duration: 4 Jul 20055 Jul 2005

Cite this

Barr, R., Stewart, A., Akula, V., Torgerson, D. J., & Reid, D. M. (2005). A randomised controlled trial (RCT) of osteoporosis screening: Long term effects on use of medication and fracture risk. Journal of Bone and Mineral Research, 20(7), 1295-1295. [OC19].