Is screening for osteoporosis useful?

ABSTRACT

Osteoporotic fractures present a major public health problem, for individuals, healthcare systems, and society. Current estimates suggest that, in developed countries, around one in three women and one in five men aged 50 years or older will have a fragility fracture during their remaining lifetime. While, in the last four decades, remarkable progress has been made in terms of our understanding of osteoporosis (we have a definition, diagnostic test (DXA), comprehensive risk assessment tools and affordable, effective treatments), but many individuals with osteoporosis are not recognized or treated - there is a huge treatment gap. Would screening for osteoporosis in the general population help to reduce fracture rates? In this session, we will discuss the current evidence for and against population based screening for high fracture risk. A large UK randomized trial of fracture risk screening using FRAX in primary care (SCOOP) demonstrated a reduction in hip fracture risk consequent to the screening intervention, and meta-analysis with two other screening trials from Denmark and the Netherlands has confirmed this effect. We will consider the evidence provided by these studies and how they may inform the practical implementation of osteoporosis screening. With a screening program comes a variety of challenges. It is cost-effectiveness must be proven and it must be acceptable to patients, doctors, and politicians alike-implementing change in overburdened healthcare systems with aging populations and in the wake of the COVID-19 pandemic is difficult. We will discuss how screening can be made economically viable, and present approaches to automated casefinding which will require minimal input from clinicians in primary care. We all want the best for our patients-we know that many are suffering fractures which could have been prevented through appropriate risk assessment and treatment-but is screening the most useful approach.