Effecacy of a population-based screening program for osteoporosis and high fracture risk in primary healthcare

Abstract

There is no unified approach to screening for high fracture risk in international practice. Objective : to evaluate the efficacy of a population-based screening program for osteoporosis and high fracture risk using the FRAX tool in postmenopausal women and men aged 40 years and older in real-world primary healthcare practice. Material and methods . A single-center prospective case-control cohort study included 34,357 individuals aged 40 years and older. In the screening group (n=10,743), primary care physicians assessed the 10-year probability of fractures using the FRAX calculator in 2018. High fracture risk was defined as exceeding the Russian FRAX intervention threshold and/or having a history of a low-energy fracture. The control group consisted of unscreened individuals (n=23,614). Screening efficacy was assessed based on changes in the incidence of osteoporotic fractures during 3 years of follow-up (2019–2021). Results and discussion . High fracture risk was identified in 16.8% of patients in the screening group. In this group, the incidence of all fractures decreased by 33.8% (from 21.0 to 13.9 per 1,000 population; p<0.001), whereas in the control group this indicator increased by 26.7% (from 8.6 to 10.9 per 1,000; p=0.012). In the subgroup of high-risk patients who received treatment, fracture incidence decreased 3.1-fold (p<0.001). Conclusion . Screening based on FRAX and a history of previous fractures is an effective strategy for reducing fracture rates in real-world clinical practice and may therefore be recommended for widespread use in primary healthcare.