Major new clinical trial of osteoporosis screening
More than 11,000 women over the age of 70 will take part in the second phase of a major clinical trial to find out if screening older woman for osteoporosis can help to reduce the numbers who suffer bone fractures.
The seven-year trial, one of the largest studies of osteoporosis in the UK, is led by researchers from the University of East Anglia with funding of £4.13 million from the Medical Research Council (MRC) and the Arthritis Research Campaign (arc).
Osteoporosis leads to 200,000 fractures a year, 86,000 of which are debilitating hip fractures. These breaks not only adversely affect the lives of those who suffer them but cost health and social services about £1.7 billion a year.
Most people are only diagnosed with the condition and treated following a fracture. In some cases these fractures are life-threatening - around 20 per cent of those who suffer a hip fracture die within the year - so early diagnosis and prevention could have huge benefits.
An arc-funded pilot study recently completed by the University of East Anglia and the University of Sheffield indicated that a systematic approach to screening older women for the disease could hold the key to early identification and treatment of those at high risk of a fracture.
The funding will enable the study to be widened to include participants living in Birmingham, Bristol, Manchester, Norwich, York, Sheffield and Southampton.
Professor Alan Silman, medical director of arc, which funded the £200,000 18-month pilot study, said the charity was pleased to be involved in the main part of the trial, adding: "This is an area of huge public interest, and if the main trial backs up the results of the pilot study, it could lead to a big change in the way that older women with osteoporosis are identified and treated in future."
Chief investigator Dr Lee Shepstone, of the University of East Anglia's School of Medicine, Health Policy and Practice, explained: "Osteoporosis is usually diagnosed using a DXA bone density scan, whose images allow the strength of bone to be assessed. At the moment, the people who are offered a scan are mainly those who have already suffered a fracture or are suspected by their GP to be at high risk.
"Given the magnitude of the public health problem and the cost to the NHS of osteoporotic fractures, it makes sense to undertake an evaluation of community-based screening, followed by the offer of treatment to those considered at high risk of fracture. A widespread and systematic screening programme could prevent fractures, saving money and, more importantly, lives."
He added that it is particularly important to assess whether mass screening is cost-effective. "An appropriately designed screening programme might reduce the large direct cost to the NHS but at the same time incur the additional costs of detection and treatment."
The Department of Health recognises the importance of this research and has confirmed that the additional clinical costs of the study, such as the time GPs will spend on the project and the extra bone density scans, will be met through the UK Clinical Research Network (UKCRN).
The study, which begins in January 2008, will recruit women in the seven new centres. They will be divided into two groups. Those in the screening group will have their risk of fracture assessed through a combination of self-reported risk factors and, in some cases, a bone scan.
If appropriate, their GP may prescribe them a course of bisphosphonate drugs to combat bone thinning; recent studies suggest these drugs can reduce fracture risk by around 50 per cent. The control group will receive 'usual care'. Both groups will be studied for five years and the number of fractures occurring in each will be compared.
The research is known as the 'SCOOP' study (Screening Of Older women for Prevention of fracture). The Medical Research Council has awarded £3.75 million with additional funding of £380,000 from the Arthritis Research Campaign.
