Screening for Osteoporotic Vertebral Fractures: A Simple, Cost-effective Tool
At the 2011 American Society for Bone and Mineral Research Annual Meeting, research was presented on a screening program for osteoporotic vertebral fractures (VF)—and how that program increases bisphosphonate prescriptions and eventually reduces the number of fractures.
The researchers were from the University of Bristol in the United Kingdom, and their paper was titled “A Screening Programme for Identification of Vertebral Fractures Increases Bisphosphonte Prescribing and Reduces Fractures: Results of a Large RCT.”
Even though it’s known that osteoporotic vertebral fractures are associated with morbidity and mortality in the elderly—and that medications can reduce fracture risk by 50%--there is no national screening program in the United Kingdom for people with osteoporotic VF.
With that in mind, the researchers wanted to see if a primary-care based VF screening program would increase the number of prescriptions for osteoporosis medicine, and then eventually reduce the fracture risk.
To study this, the researchers did a randomized controlled trial of 3,200 women ages 65-80. There were subject from 15 General Practices in the Bristol area, and there were no exclusion criteria.
For the women in the active group, a nurse in a primary care setting used a simple screening tool (developed from a previous cross sectional study) in order to identify women who were at a high risk of VF.
Those women who were identified as high risk were offered a thoracolumbar radiograph (done at their local hospital), and results were sent back to the subject’s General Practitioner.
Women in the control group did not receive the screening tool or the radiograph.
For the main outcome measure, intention-to-treat was used for analysis; this was self-reported prescription of osteoporosis medication at 6 months. The secondary outcome was self-reported new fracture incidence.
The study found that in the active group (the screening group), osteoporosis medication prescriptions was increased by 124% compared to the control group (95% CI; 1.16-4.33). 64.3% of the subjects who were prescribed bisphosphonates within 6 months had been identified as definitely or probably having a VF. It was also seen in the active group that fracture incidence was reduced by 72% versus the control group; this was at 6 to 12 months follow-up (95% CI; 0.12-0.67).
The researchers concluded that the simple screening tool for VF in older postmenopausal women can reduce fracture incidence by increasing bisphosphonate prescriptions. This suggests that such a tool would be highly cost effective.