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Effectiveness of a two-step population-based osteoporosis screening program using FRAX: the randomized Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study

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DOI

  • Katrine Hass Rubin, OPEN-Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense C, Denmark. krubin@health.sdu.dk.
  • ,
  • Mette Juel Rothmann, Syddansk Universitet
  • ,
  • Teresa Holmberg, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
  • ,
  • M Høiberg, Department of Research, Hospital of Southern Norway, Kristiansand, Norway.
  • ,
  • S Möller, Syddansk Universitet
  • ,
  • Reinhard Barkmann, Department of Diagnostic Radiology, Molecular Imaging North Competence Center (MOIN CC), University Hospital Schleswig-Holstein in Kiel, Kiel, Germany.
  • ,
  • C C Glüer, Department of Diagnostic Radiology, Molecular Imaging North Competence Center (MOIN CC), University Hospital Schleswig-Holstein in Kiel, Kiel, Germany.
  • ,
  • Anne Pernille Hermann, Syddansk Universitet
  • ,
  • Mickael Bech, VIVE - The Danish Center for Social Science Research
  • ,
  • J Gram, Syddansk Universitet, 11 Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark.
  • ,
  • K Brixen, Syddansk Universitet

The Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study investigated the effectiveness of a two-step screening program for osteoporosis in women. We found no overall reduction in fractures from systematic screening compared to the current case-finding strategy. The group of moderate- to high-risk women, who accepted the invitation to DXA, seemed to benefit from the program.

INTRODUCTION: The purpose of the ROSE study was to investigate the effectiveness of a two-step population-based osteoporosis screening program using the Fracture Risk Assessment Tool (FRAX) derived from a self-administered questionnaire to select women for DXA scan. After the scanning, standard osteoporosis management according to Danish national guidelines was followed.

METHODS: Participants were randomized to either screening or control group, and randomization was stratified according to age and area of residence. Inclusion took place from February 2010 to November 2011. Participants received a self-administered questionnaire, and women in the screening group with a FRAX score ≥ 15% (major osteoporotic fractures) were invited to a DXA scan. Primary outcome was incident clinical fractures. Intention-to-treat analysis and two per-protocol analyses were performed.

RESULTS: A total of 3416 fractures were observed during a median follow-up of 5 years. No significant differences were found in the intention-to-treat analyses with 34,229 women included aged 65-80 years. The per-protocol analyses showed a risk reduction in the group that underwent DXA scanning compared to women in the control group with a FRAX ≥ 15%, in regard to major osteoporotic fractures, hip fractures, and all fractures. The risk reduction was most pronounced for hip fractures (adjusted SHR 0.741, p = 0.007).

CONCLUSIONS: Compared to an office-based case-finding strategy, the two-step systematic screening strategy had no overall effect on fracture incidence. The two-step strategy seemed, however, to be beneficial in the group of women who were identified by FRAX as moderate- or high-risk patients and complied with DXA.

OriginalsprogEngelsk
TidsskriftOsteoporosis International
Vol/bind29
Nummer3
Sider (fra-til)567-578
Antal sider12
ISSN0937-941X
DOI
StatusUdgivet - mar. 2018
Eksternt udgivetJa

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