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Related Concept Videos

Study Designs in Epidemiology01:20

Study Designs in Epidemiology

Epidemiological study designs are fundamental tools for investigating the distribution, determinants, and control of health conditions in populations. They help researchers understand the relationships between exposures and outcomes, and they broadly fall into two categories: "observational" and "experimental" studies.
Observational studies are those where the researcher does not intervene but rather observes natural variations. They include cross-sectional, cohort, and case-control studies.

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Related Experiment Video

Updated: Jul 11, 2026

Semiautomated Longitudinal Microcomputed Tomography-based Quantitative Structural Analysis of a Nude Rat Osteoporosis-related Vertebral Fracture Model
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Effectiveness of a two-step population-based osteoporosis screening program using FRAX: the randomized

K H Rubin1, M J Rothmann2,3, T Holmberg4

  • 1OPEN-Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense C, Denmark. krubin@health.sdu.dk.

Osteoporosis International : a Journal Established As Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
|December 9, 2017
PubMed
Summary

The Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study found that a two-step osteoporosis screening program did not reduce overall fractures. However, moderate- to high-risk women who accepted DXA scans showed a benefit in fracture reduction.

Keywords:
FRAXFractureOsteoporosisPopulation-based screeningPreventionWomen

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Area of Science:

  • Gerontology
  • Public Health
  • Radiology

Background:

  • Osteoporosis poses a significant fracture risk in aging populations.
  • Current case-finding strategies for osteoporosis may not be universally effective.
  • Systematic screening aims to identify at-risk individuals earlier for intervention.

Purpose of the Study:

  • To evaluate the effectiveness of a two-step, population-based osteoporosis screening program.
  • To assess the utility of the Fracture Risk Assessment Tool (FRAX) in selecting women for DXA scans.
  • To compare systematic screening against standard case-finding for fracture reduction.

Main Methods:

  • Randomized controlled trial involving 34,229 women aged 65-80.
  • Two-step screening: FRAX questionnaire followed by DXA scan for high-risk individuals (FRAX score ≥15%).
  • Intention-to-treat and per-protocol analyses over a median 5-year follow-up.

Main Results:

  • No significant difference in overall fracture incidence between screening and control groups (intention-to-treat analysis).
  • Per-protocol analysis revealed a risk reduction for major osteoporotic, hip, and all fractures in women who underwent DXA.
  • The most pronounced benefit was observed for hip fractures (adjusted SHR 0.741).

Conclusions:

  • A two-step systematic osteoporosis screening strategy showed no overall fracture reduction compared to case-finding.
  • The screening approach appears beneficial for moderate- to high-risk women who undergo DXA scanning.
  • Targeted screening may improve outcomes for specific patient subgroups identified by risk assessment.