FRAX Score Improves Secondary Fracture Prevention

Camille Parsons, PhD

A new analysis of data from the Screening for Osteoporosis in Older Women for the Prevention of Fracture (SCOOP) trial is shedding light on the use of FRAX for secondary fracture prevention.

Results of the study, which were presented at the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO-IOF-ESCEO) 2020 conference, indicate assessment and treatment of osteoporosis guided by FRAX effectively reduced risk of incident fractures in a secondary prevention setting.

“This analysis provides randomize decontrolled trial evidence that in women aged 70-85 years from the general population in the UK selected on the basis of prior fracture, FRAX risk assessment and treatment targeting was associate with substantial reduction in the incidence of secondary fracture—both hip and osteoporotic,” said study presenter C. Parsons, PhD, of the MRC Lifecourse Epidemiology Unit at University of Southampton, during her presentation at WCO-IOF-ESCEO 2020.

To further understand the effectiveness of FRAX for secondary fracture prevention, Parsons and a team of colleagues designed the current study as a post-hoc analysis of the SCOOP trial. Briefly, the SCOOP trial examined the impact primary care fracture risk screening can have on prevalence of hip fractures and this trial provided data related 12,483 patients for the current study.

Over the 5-year follow-up period included in the SCOOP trial, patients completed postal questionnaires detailing new incident fractures and use of anti-osteoporosis medications. In these questionnaires, incident major osteoporotic fractures were defined as hip, clinical vertebral, and wrist or humerus. Investigators noted Cox proportional hazard models were used to examine associations in incident fracture among patients by randomization group.

Of the 12,483 included in the study, 6233 underwent screening using FRAX and 6250 underwent usual care. Upon analysis, investigators found just 2862 patients in the overall study had experienced a fracture prior to randomization. Of these 2862, 1399 underwent screening including FRAX and 1463 underwent usual care. Investigators pointed out patients identified as high risk of fracture based on FRAX scores were put on anti-osteoporotic treatment.

At the end of the follow-up period, a total of 286 incident fractures were recorded in the screening arm compared to 332 in the usual care arm. Of the 286 fractures in the screening group, 173 were major osteoporotic fractures and 43 were hip fractures. Of the 332 in the usual care group, 241 were major osteoporotic fractures and 80 were hip fractures.

In the hazard models, the screening intervention was associated with a 26% lower risk of major osteoporotic fracture (HR, 0.74; 95% CI, 0.61-0.90; P=.002 and a 44% lower risk of hip fracture (HR=0.56, 95% CI, 0.38-0.81; P=.002 when compared to usual care for patients with a prior fracture.

“The results of this research, if confirmed in additional studies, could inform approaches to stratification of treatment by fracture risk. This serves to highlight the critical positioning of secondary fracture prevention strategies in global health policies addressing healthy aging,” said Parsons during her presentation.

This study, “Fracture Risk Screening Using FRAX is Effective For Secondary Fracture Prevention: A Post-Hoc Analysis of the SCOOP Trial,” was presented at WCO-IOF-ESCEO 2020.