SCOOP

Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial

Shepstone L, Lenaghan E, Cooper C, et al. Lancet (London, England) 2018 · PMID 29254858 · doi:10.1016/s0140-6736(17)32640-5

Question

Does systematic community screening of older women using FRAX (with DXA where indicated) reduce fractures compared with usual care?

Design

Pragmatic multicentre RCT in UK primary care (seven regions).

Patients

Women aged 70 to 85 registered with 100 UK general practices who were not already taking osteoporosis medication.

Intervention

FRAX screening (with DXA where indicated), with treatment recommended for those at high FRAX-predicted hip fracture risk

Comparison

Usual care

Primary outcome

Any osteoporosis-related fracture over 5 years

Key result

Screening increased uptake of osteoporosis medication but did not significantly reduce the primary outcome of all osteoporosis-related fractures; hip fractures, a prespecified secondary outcome, were reduced.

Limitations

Pragmatic design meant treatment uptake depended on GPs and patients; adherence to medication was not controlled.

Impact on practice

Supports targeted FRAX-based case-finding in older women to prevent hip fractures and informs the UK debate on population screening.