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Randomized Controlled Trial
. 2020 Jan;31(1):67-75.
doi: 10.1007/s00198-019-05142-z. Epub 2019 Oct 12.

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

C M Parsons  1 , N Harvey  1   2 , L Shepstone  3 , J A Kanis  4   5 , E Lenaghan  3 , S Clarke  6 , R Fordham  3 , N Gittoes  7 , I Harvey  3 , R Holland  3 , N M Redmond  6   8 , A Howe  3 , T Marshall  3 , T J Peters  6 , D Torgerson  9 , T W O'Neill  10   11 , E McCloskey  4   12   13 , C Cooper  14   15   16 ; SCOOP Trial Group
Collaborators, Affiliations
Randomized Controlled Trial

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

C M Parsons et al. Osteoporos Int. 2020 Jan.

Abstract

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®; Medication; Osteoporosis; Screening.

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Conflict of interest statement

Disclosures

CC has received consultancy fees and honoraria from Amgen, Danone, Eli Lilly, GlaxoSmithKline, Medtronic, Merck, Nestlé, Novartis, Pfzer, Roche, Servier, Shire, Takeda, and UCB. NH has received consultancy, lecture fees, and honoraria from Alliance for Better Bone Health, Amgen, MSD, Eli Lilly, Servier, Shire, UCB, Consilient Healthcare, and Internis Pharma. JK has held grants from Amgen, Lilly, Unigene, and Radius Health; has received non-fnancial support from Medimaps, Asahi, and AgNovos; and is the architect of FRAX®, but has no financial interest. EM has been, or currently is, an adviser or speaker for and has received research support from ActiveSignal, Amgen, AstraZeneca, Consilient Healthcare, GlaxoSmithKline, Hologic, Internis, Eli Lilly, Medtronic, Merck, Novartis, Pfzer, Roche, Sanof-Aventis, Servier, Synexus, Tethys, UCB, and Warner Chilcott; and has received research support from I3 Innovus, International Osteoporosis Foundation, and Unilever. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Consort diagram
Figure 2
Figure 2
Anti-osteoporosis medication use over the duration of the SCOOP trial by randomisation group [screening (intervention) vs usual care (control)].
Figure 3
Figure 3
a: Anti-osteoporosis medication (AOM) adherence over the 5 year duration of the SCOOP trial in study participants who initiated treatment, and who had not experienced a fracture between baseline and commencement of medication. (Calculated as the percent study participants who remained on AOM at each subsequent timepoint having initiated treatment at each index timepoint.) b: Anti-osteoporosis medication (AOM) adherence over the 5 year duration of the SCOOP trial in study participants who initiated treatment after the occurrence of a fracture post-baseline. (Calculated as the percent study participants who remained on AOM at each subsequent timepoint having initiated treatment at each index timepoint.)
See this image and copyright information in PMC

References

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