New Bristol research could lead to national screening for osteoporosis
New research in Bristol could lead to a dramatic improvement in the health of older women with osteoporosis by ensuring that they receive the treatment they need.
Nearly 4,000 women from the city between the ages of 65 and 80 will be recruited into the study.
GPs rarely refer patients with back pain for an x-ray which could confirm a diagnosis of osteoporosis. As a result, up to 90 per cent of all vertebral (spinal) fractures go undiagnosed; even though the women who suffer them are at risk of further fracture, have a reduced quality of life and an increased rate of mortality.
Now the Arthritis Research Campaign has awarded Dr Emma Clark at the University of Bristol a Clinician Scientist Fellowship of £427,007 over three years to identify the women at risk by screening them. These women will then be offered drugs which could reduce the likelihood of a further fracture by 50 per cent.
If the screening programme is proven to be clinically and cost effective it could lead to a major policy change in the way older women are treated nationally.
Dr Clark, who is based at the university’s department of Social Medicine, and is also an honorary consultant rheumatologist at the Bristol Royal Infirmary, said that there were a number of reasons why vertebral fractures were undiagnosed.
“Sometimes a vertebral fracture is not painful so the patient won’t realise it has happened. If the fracture is painful this will cause back pain. But as about 30 per cent of the population has back pain anyway, GPs are dissuaded from referring these patients for an x-ray, as for most people with back pain having an x-ray won’t help them.”
Dr Clark and her team now plan to recruit 3,800 women aged between 65 and 80 from up to 30 GP practices in Bristol.
Half of them will be randomised into a group to be screened for osteoporosis by answering questions about their health and having an examination. Those who are considered to be at risk of having further fractures will then be x-rayed to confirm the diagnosis, and then started on drugs that rebuild bone called bisphosphonates. The primary outcome measure will be changes in the proportion of the women who take bisphosphonate drugs.
The other half of the women will be randomised into a group which will not be screened. Dr Clark will also conduct an analysis of the potential costs of x-raying all women between the ages of 65 and 80 in order to detect osteoporosis.
“The purpose of the study is to find out if x-raying women is useful in identifying women at risk of osteoporosis and suffering further fractures, and will provide practicable evidence how GPs can use a simple risk-factor assessment to identify women at high risk of vertebral fracture,” added Dr Clark.
