SELF-ADMINISTERED questionnaires as screening tools for osteoporosis are not sufficient for systematic screening due to low and differential screening uptake, according to a new study presented at the 2024 World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO IOF-ESCEO).
Osteoporotic fractures are a burgeoning public health challenge, with osteoporosis being frequently underdiagnosed and undertreated. Systematic screening programmes are crucial to address this issue. Thus, in a 10-year follow-up of the ROSE randomised trial, the effectiveness of a two-step population-based osteoporotic screening programme was evaluated.
The ROSE study utilised a two-step screening programme, where approximately 35,000 females from the Region of Southern Denmark (65–80 years) were randomised into two groups; one control and one screening. They were all mailed a questionnaire that could be used to calculate their 10-year probability of osteoporotic fracture using the Fracture Risk Assessment Tool (FRAX). Females in the screening group with a FRAX value ≥15% were invited for a dual-energy X-ray absorptiometry (DXA) scan following standard osteoporosis treatment.
In the follow-up, 7,355 major osteoporotic fractures were observed, but no differences in incidents between the control and screening groups were identified. This is despite the fact that, pre-protocol, females with a FRAX value ≥15%, who were DXA-scanned, exhibited a 14% lower incidence of major osteoporotic fractures than controls. Similar trends were observed for hip fractures, all fractures, and mortality.
These findings suggest that the ROSE programme did not demonstrate an overall effect on osteoporotic fracture incidence or mortality. However, it exhibited a preventive effect for females at moderate-to-high risk who underwent DXA scans, and therefore the lack of overall effectiveness may be attributed to participants not meeting the intervention risk threshold or non-compliance with DXA scanning. The use of self-administered questionnaires as screening tools may also be inefficient due to low and differential screening uptake. Screening is still a vital preventative step for patients with osteoporosis, and thus research is now being directed towards alternative methods that may be more effective.
