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

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

Research output: Contribution to journalAbstractpeer-review


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 45-54 years living within 32km of Aberdeen, Scotland, was selected from a primary health care register. Subjects were randomised in equal numbers to screening (active (A)) or no screening (inactive controls (C)). 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 C=56.8% and A=59.7%. No significant differences between the groups were observed in: age, weight, height or self-reported general health, nor in self-reported disease states with the exception of hyperparathyroidism (C=0.5% A=1.1%, p=0.05). 52.4% of the active group reported taking HRT compared with 44.5% of the control group (p<0.001). No significant difference was observed in the mean duration of HRT use (C=86.0 months A=84.0 months p=0.58). 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, excluding HRT, (p<0.001)). A significantly greater number of the active group not advised to take HRT at screening compared with the control group had taken HRT (49.7% vs 44.5%, p=0.017). This trend was repeated in the use of other osteoporosis medications.
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 (C=13.9% A=15.6%, p=0.202) or the rate of falls (C=0.28falls/year A=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 number1042
Pages (from-to)S12-S12
Number of pages1
JournalJournal of Bone and Mineral Research
Issue number9
Publication statusPublished - Sep 2005
Event27th Annual Meeting of the American Society for Bone and Mineral Research - Nashville, United States
Duration: 23 Sep 200527 Sep 2005


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