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Screening Elderly Women for Risk of Future Fractures—Participation Rates and Impact on Incidence of Falls and Fractures

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Abstract

We have assessed the acceptability of a method for screening for risk of future hip fracture in elderly women. After receipt of an initial response to a mailed risk-factor questionnaire sent out to 5,306 women, women were randomly assigned to active or control groups. The active group was invited to participate in a screening visit that comprised a life-style questionnaire and a quantitative ultrasound heel scan. General practitioners (GPs) of women who were found to be in the lowest quartile of broadband ultrasound attenuation and/or who had two or more risk factors for hip fracture were advised to prescribe a calcium and vitamin D supplement. A second mailed questionnaire was sent to both groups 1 to 3 years later. Compared with the control group, the active group had a 56% lower risk of fracture (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.24–0.81 adjusted age, weight, and treatment status). At follow-up, the proportion of fallers in the active group (25.3%) was lower than that in the control group (29.6%) (P = 0.064). The control group was found to have a higher rate of falls at follow-up than the active group (95% CI, 0.02–0.22); no difference was found at baseline (95% CI, −0.08 to +0.14). The screening method used was found to be acceptable to the majority of elderly women in this study. Screening the elderly in this way together with simple advice on treatment appears to reduce the age-associated increase in fall rates and the number of subsequent fractures. This form of screening may provide a cost-effective method to reduce falls and fractures in free-living elderly women. However, no such cost-effectiveness analysis has been performed to date.

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Acknowledgments

We are grateful to Research into Ageing/Age Concern for providing the initial funding for the study, and, later, Strakan Pharmaceuticals for the follow-up study. We would also like to express our thanks to Arthur Stewart, Lisa Calder, and Lesley Adams who carried out some of the screening visits in the GP practices, the rest of which were carried out by the author (R.B.). D.M.R. is grateful to the Arthritis Research Campaign for continued core-funding support. A.S. is an Arthritis Research Campaign Postdoctoral Research Fellow.

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Correspondence to D. M. Reid.

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Barr, R.J., Stewart, A., Torgerson, D.J. et al. Screening Elderly Women for Risk of Future Fractures—Participation Rates and Impact on Incidence of Falls and Fractures. Calcif Tissue Int 76, 243–248 (2005). https://doi.org/10.1007/s00223-004-0101-5

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  • DOI: https://doi.org/10.1007/s00223-004-0101-5

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