. 2022 Jun 28;17(1):87.

doi: 10.1007/s11657-022-01117-6.

Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group

P Chotiyarnwong^{1

2}, E V McCloskey^{3

4}, N C Harvey⁵, M Lorentzon^{6

7}, D Prieto-Alhambra^{8

9}, B Abrahamsen^{10

11}, J D Adachi¹², F Borgström^{13

14}, O Bruyere¹⁵, J J Carey^{16

17}, P Clark¹⁸, C Cooper⁵, E M Curtis⁵, E Dennison⁵, M Diaz-Curiel¹⁹, H P Dimai²⁰, D Grigorie^{21

22}, M Hiligsmann²³, P Khashayar²⁴, E M Lewiecki²⁵, P Lips²⁶, R S Lorenc²⁷, S Ortolani²⁸, A Papaioannou^{29

30}, S Silverman³¹, M Sosa³², P Szulc³³, K A Ward⁵, N Yoshimura³⁴, J A Kanis^{35

7}

Affiliations

¹ Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK.
² Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
³ Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK. e.v.mccloskey@sheffield.ac.uk.
⁴ Centre for Metabolic Bone Diseases, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK. e.v.mccloskey@sheffield.ac.uk.
⁵ MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
⁶ University of Gothenburg, Gothenburg, Sweden.
⁷ Australian Catholic University, Melbourne, Australia.
⁸ Oxford NIHR Biomedical Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.
⁹ GREMPAL (Grup de Recerca en Malalties Prevalents de L'Aparell Locomotor) Research Group, CIBERFes and Idiap Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Gran Via de Les Corts Catalanes, 591 Atico, 08007, Barcelona, Spain.
¹⁰ Department of Clinical Research, Odense Patient Data Exploratory Network, University of Southern Denmark, Odense, Denmark.
¹¹ Department of Medicine, Holbæk Hospital, Holbæk, Denmark.
¹² Department of Medicine, Michael G DeGroote School of Medicine, St Joseph's Healthcare-McMaster University, Hamilton, ON, Canada.
¹³ Quantify Research, Stockholm, Sweden.
¹⁴ Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
¹⁵ WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
¹⁶ School of Medicine, National University of Ireland Galway, Galway, Ireland.
¹⁷ Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
¹⁸ Clinical Epidemiology Unit of Hospital Infantil de México Federico Gómez-Faculty of Medicine, Universidad Nacional Autónoma de México, UNAM, Mexico City, Mexico.
¹⁹ Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
²⁰ Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
²¹ Carol Davila University of Medicine, Bucharest, Romania.
²² Department of Endocrinology & Bone Metabolism, National Institute of Endocrinology, Bucharest, Romania.
²³ Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
²⁴ Center for Microsystems Technology, Imec and Ghent University, 9050, Ghent, Belgium.
²⁵ New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
²⁶ Department of Internal Medicine, Endocrine Section & Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
²⁷ Multidisciplinary Osteoporosis Forum, SOMED, Warsaw, Poland.
²⁸ IRCCS Istituto Auxologico, UO Endocrinologia E Malattie del Metabolismo, Milano, Italy.
²⁹ Department of Medicine, McMaster University, Hamilton, ON, Canada.
³⁰ GERAS Centre for Aging Research, Hamilton, ON, Canada.
³¹ Cedars-Sinai Medical Center, Los Angeles, CA, USA.
³² Bone Metabolic Unit, University of Las Palmas de Gran Canaria, Hospital University Insular, Las Palmas, Gran Canaria, Spain.
³³ INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
³⁴ Department of Preventive Medicine for Locomotive Organ Disorders, 22Nd Century Medical and Research Center, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.
³⁵ Centre for Metabolic Bone Diseases, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK.

PMID: 35763133
PMCID: PMC9239944
DOI: 10.1007/s11657-022-01117-6

Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group

P Chotiyarnwong et al. Arch Osteoporos. 2022.

. 2022 Jun 28;17(1):87.

doi: 10.1007/s11657-022-01117-6.

Authors

Affiliations

¹ Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK.
² Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
³ Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK. e.v.mccloskey@sheffield.ac.uk.
⁴ Centre for Metabolic Bone Diseases, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK. e.v.mccloskey@sheffield.ac.uk.
⁵ MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
⁶ University of Gothenburg, Gothenburg, Sweden.
⁷ Australian Catholic University, Melbourne, Australia.
⁸ Oxford NIHR Biomedical Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.
⁹ GREMPAL (Grup de Recerca en Malalties Prevalents de L'Aparell Locomotor) Research Group, CIBERFes and Idiap Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Gran Via de Les Corts Catalanes, 591 Atico, 08007, Barcelona, Spain.
¹⁰ Department of Clinical Research, Odense Patient Data Exploratory Network, University of Southern Denmark, Odense, Denmark.
¹¹ Department of Medicine, Holbæk Hospital, Holbæk, Denmark.
¹² Department of Medicine, Michael G DeGroote School of Medicine, St Joseph's Healthcare-McMaster University, Hamilton, ON, Canada.
¹³ Quantify Research, Stockholm, Sweden.
¹⁴ Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
¹⁵ WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
¹⁶ School of Medicine, National University of Ireland Galway, Galway, Ireland.
¹⁷ Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
¹⁸ Clinical Epidemiology Unit of Hospital Infantil de México Federico Gómez-Faculty of Medicine, Universidad Nacional Autónoma de México, UNAM, Mexico City, Mexico.
¹⁹ Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
²⁰ Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
²¹ Carol Davila University of Medicine, Bucharest, Romania.
²² Department of Endocrinology & Bone Metabolism, National Institute of Endocrinology, Bucharest, Romania.
²³ Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
²⁴ Center for Microsystems Technology, Imec and Ghent University, 9050, Ghent, Belgium.
²⁵ New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
²⁶ Department of Internal Medicine, Endocrine Section & Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
²⁷ Multidisciplinary Osteoporosis Forum, SOMED, Warsaw, Poland.
²⁸ IRCCS Istituto Auxologico, UO Endocrinologia E Malattie del Metabolismo, Milano, Italy.
²⁹ Department of Medicine, McMaster University, Hamilton, ON, Canada.
³⁰ GERAS Centre for Aging Research, Hamilton, ON, Canada.
³¹ Cedars-Sinai Medical Center, Los Angeles, CA, USA.
³² Bone Metabolic Unit, University of Las Palmas de Gran Canaria, Hospital University Insular, Las Palmas, Gran Canaria, Spain.
³³ INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
³⁴ Department of Preventive Medicine for Locomotive Organ Disorders, 22Nd Century Medical and Research Center, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.
³⁵ Centre for Metabolic Bone Diseases, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK.

PMID: 35763133
PMCID: PMC9239944
DOI: 10.1007/s11657-022-01117-6

Abstract

The IOF Epidemiology and Quality of Life Working Group has reviewed the potential role of population screening for high hip fracture risk against well-established criteria. The report concludes that such an approach should strongly be considered in many health care systems to reduce the burden of hip fractures.

Introduction: The burden of long-term osteoporosis management falls on primary care in most healthcare systems. However, a wide and stable treatment gap exists in many such settings; most of which appears to be secondary to a lack of awareness of fracture risk. Screening is a public health measure for the purpose of identifying individuals who are likely to benefit from further investigations and/or treatment to reduce the risk of a disease or its complications. The purpose of this report was to review the evidence for a potential screening programme to identify postmenopausal women at increased risk of hip fracture.

Methods: The approach took well-established criteria for the development of a screening program, adapted by the UK National Screening Committee, and sought the opinion of 20 members of the International Osteoporosis Foundation's Working Group on Epidemiology and Quality of Life as to whether each criterion was met (yes, partial or no). For each criterion, the evidence base was then reviewed and summarized.

Results and conclusion: The report concludes that evidence supports the proposal that screening for high fracture risk in primary care should strongly be considered for incorporation into many health care systems to reduce the burden of fractures, particularly hip fractures. The key remaining hurdles to overcome are engagement with primary care healthcare professionals, and the implementation of systems that facilitate and maintain the screening program.

Keywords: Cost-effectiveness; FRAX; Fracture risk; Screening; Treatment.

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Conflict of interest statement

E.V.M reports consultant/advisor fees, speaker honoraria and or, research funding from AgNovos, Amgen, Consilient Healthcare, Fresenius Kabi, Gedeon Richter, Internis, Lilly, Novartis, ObsEva, Synexus and UCB, all outside the submitted work. E.M.C. reports lecture fees and travel support from Eli Lilly, Pfizer and UCB, outside the submitted work. N.C.H. reports personal fees, consultancy, lecture fees and honoraria from Alliance for Better Bone Health, AMGEN, MSD, Eli Lilly, UCB, Kyowa Kirin, Servier, Shire, Consilient Healthcare and Internis Pharma, outside the submitted work. J.A.K. reports a grant from UCB, outside the submitted work. He is the architect of FRAX® but has no financial interest. C.C. reports personal fees from ABBH, Amgen, Eli Lilly, GSK, Medtronic, Merck, Novartis, Pfizer, Roche, Servier and Takeda, outside the submitted work. B.A. reports grants and personal fees from UCB, personal fees from Amgen, grants from Novartis, grants and personal fees from Pharma-cosmos, grants and personal fees from Kyowa Kirin, personal fees for Gedeon Richter outside the submitted work. BA also serves on the NovoNordisk Foundation Grants Committee on Endocrinology and Metabolism. M.L. reports lecture fees from Amgen, Astellas, Lilly, Meda, Renapharma and UCB Pharma and consulting fees from Amgen, Radius Health, UCB Pharma, Renapharma and Consilient Health, outside the submitted work. D.P-A. reports institutional receipt of speaker fees from AMGEN and UCB Biopharma; consultancy fees from UCB Biopharma; research grants from UCB, Amgen, and Les Laboratoires Servier, all outside of the submitted work. J. A. reports grants and personal fees from Amgen outside the submitted work, grants from Radius and has been an advisor to Gilead and is part of their speaker’s bureau, outside the submitted work. F.B. is employed and is a shareholder in Quantify Research, a health economic research consultancy, outside of the submitted work. O.B. reports grant support from IBSA, MSD, Nutraveris, Novartis, Pfizer, Rottapharm, Servier and Theramex; consulting or lecture fees from Bayer, Genevrier, IBSA, Rottapharm, Servier, SMB and TRB Chemedica; all outside the submitted work. All other authors have no relevant conflicts of interest in relation to the submitted work.

Figures

**Fig. 1**
An example of the FRAX® fracture risk assessment tool webpage for the UK FRAX calculator. The UK calculator is linked through to the guidance pages of the National Osteoporosis Guideline Group (View NOGG Guidance button)

**Fig. 2**
A systematic approach to fracture prevention adapted from that outlined by the Department of Health in the UK. FLS — fracture liaison services

**Fig. 3**
Expected and observed incidences of hip fracture in the control and screening arms of the SCOOP study. The number of hip fractures within each group is shown in white text within the bars. The percentages in blue represent the crude incidences of hip fracture

**Fig. 4**
Forest plots of screening for prevention of hip (A, adapted from [149]) and major osteoporotic (B) fractures versus usual care. Note: From the ROSE study, the data from the first per protocol analysis were used, as these were most comparable to the data from the SCOOP and SOS studies. In B, the meta-analysis from [149] has been updated to include the major osteoporotic fracture outcome from the SCOOP study. A Outcome — hip fracture, B Outcome — major osteoporotic fracture

See this image and copyright information in PMC

References

1. Wilson JMG, Jungner G (1968) Principles and practice of screening for disease. World Health Organization https://apps.who.int/iris/handle/10665/37650. Accessed 18 Aug 2021
1. Shepstone L, Fordham R, Lenaghan E, et al. A pragmatic randomised controlled trial of the effectiveness and cost-effectiveness of screening older women for the prevention of fractures: rationale, design and methods for the SCOOP study. Osteoporos Int. 2012;23:2507–2515. doi: 10.1007/s00198-011-1876-7. - DOI - PubMed
1. Shepstone L, Lenaghan E, Cooper C, et al. Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial. Lancet. 2018;391:741–747. doi: 10.1016/S0140-6736(17)32640-5. - DOI - PubMed
1. McCloskey E, Johansson H, Harvey NC, et al. Management of patients with high baseline hip fracture risk by FRAX reduces hip fractures-a post hoc analysis of the SCOOP study. J Bone Miner Res. 2018;33:1020–1026. doi: 10.1002/jbmr.3411. - DOI - PMC - PubMed
1. Parsons CM, Harvey N, Shepstone L, et al. Systematic screening using FRAX((R)) leads to increased use of, and adherence to, anti-osteoporosis medications: an analysis of the UK SCOOP trial. Osteoporos Int. 2019;31:67–75. doi: 10.1007/s00198-019-05142-z. - DOI - PMC - PubMed

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Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group

Affiliations

Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

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