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Publication - Dr Ginny Gould

    Randomised controlled trial of a primary care-based screening programme to identify older women with prevalent osteoporotic vertebral fractures (COSHIBA)

    Citation

    Clark, E, Gould, V, Morrison, L, Ades, A, Dieppe, P & Tobias, JH, 2012, ‘Randomised controlled trial of a primary care-based screening programme to identify older women with prevalent osteoporotic vertebral fractures (COSHIBA)’. Journal of Bone and Mineral Research, vol 27., pp. 664-671

    Abstract

    Approximately 12% of postmenopausal women have osteoporotic vertebral fractures (VFs) and these are associated with excess morbidity and mortality, and high risk of future osteoporotic fractures. Despite this less than one third come to clinical attention, partly due to lack of clear clinical triggers for referral for spinal radiographs. The aim of this study was to investigate whether a novel primary care-based screening tool could be used to identify postmenopausal women with osteoporotic VFs and increase appropriate management of osteoporosis. A randomised controlled trial was undertaken in 15 General Practices within the Bristol area of the UK. 3200 women aged 65 to 80 years were enrolled, with no exclusion criteria. A simple screening tool was carried out by a nurse in primary care to identify women at high risk of osteoporotic VFs. All identified high-risk women were offered a diagnostic thoraco-lumbar radiograph. Radiographs were reported using standard NHS reporting with results sent back to each participant's General Practitioner. Participants in the control arm did not receive the screening tool or radiographs. The main outcome measure was self-reported prescription of medication for osteoporosis at 6 months with a random 5% sub-sample verified against electronic GP records. Secondary outcome was self-reported incidence of new fractures. Results showed that allocation to screening increased prescription of osteoporosis medications by 124% (OR for prescription 2 · 24 at 6 months (95%CI 1 · 16 to 4 · 33). Allocation to screening also reduced fracture incidence at 12-months follow-up (OR for new fracture 0.60, 95%CI 0.35 to 1.03, P = 0.063), although this did not reach statistical significance. This study supports the use of a simple screening tool administered in primary care to increase appropriate prescription of medications for osteoporosis in postmenopausal women in the UK. © 2011 American Society for Bone and Mineral Research.

    Full details in the University publications repository