STOP fracture study: southern health osteoporotic fracture screening project

Osteoporosis is a major healthcare issue with over 50% of postmenopausal women suffering an osteoporosis-related fracture. Vertebral fractures, the commonest, are often asymptomatic, unrecognised and untreated.

In a high risk population we aimed to screen for vertebral fractures with a lateral chest X-ray then to intervene to highlight risk and improve fracture prevention.

In this prospective interventional study, 104 postmenopausal women, presenting to hospital for unrelated conditions, were recruited. A baseline lateral chest X-ray and fracture risk questionnaire was completed with a follow-up questionnaire at 12 months. Where fractures were detected the study team intervened through correspondence, including evidence-based guidelines recommending investigations and management to patients and general practitioners.

Ninety-six women had a lateral chest X-ray with 53 (55%) having vertebral fractures. Sixty-five women completed baseline questionnaires and 64/65 had a calculated 5-year fracture risk greater than 10%. At 12 months, 21% were commenced or continued on bisphosphonates with 17% adhering to therapy while eight had sustained a subsequent symptomatic fracture and eight women had died.

Fifty-five per cent of women over 65 years, presenting to hospital with unrelated medical conditions, had a previous minimal trauma vertebral fracture on lateral chest X-ray. Potentially, a lateral chest X-ray may provide a simple effective screening tool for osteoporotic fracture in this high-risk population. Despite notification and recommendations to both patients and general practitioners, treatment uptake was poor, highlighting the need for further research into risk perception and behaviour change in both practitioners and patients.