{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T01:52:37Z","timestamp":1784771557099,"version":"3.55.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2011,11,23]],"date-time":"2011-11-23T00:00:00Z","timestamp":1322006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Approximately 12% of postmenopausal women have osteoporotic vertebral fractures (VFs); these are associated with excess morbidity and mortality and a 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\u2013based screening tool could be used to identify postmenopausal women with osteoporotic VFs and increase appropriate management of osteoporosis. A randomized controlled trial was undertaken in 15 general practices within the Bristol area of the UK. A total of 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 thoracolumbar radiograph. Radiographs were reported using standard National Health Service (NHS) reporting, with results sent back to each participant's general practitioner (GP). 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% subsample 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% (odds ratio [OR] for prescription 2.24 at 6 months; 95% confidence interval [CI], 1.16 to 4.33). Allocation to screening also reduced fracture incidence at 12-month follow-up (OR for new fracture 0.60; 95% CI, 0.35\u20131.03; p\u2009=\u20090.063), 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. \u00a9 2012 American Society for Bone and Mineral Research<\/jats:p>","DOI":"10.1002\/jbmr.1478","type":"journal-article","created":{"date-parts":[[2011,11,23]],"date-time":"2011-11-23T15:31:30Z","timestamp":1322062290000},"page":"664-671","source":"Crossref","is-referenced-by-count":50,"title":["Randomized controlled trial of a primary care\u2013based screening program to identify older women with prevalent osteoporotic vertebral fractures: Cohort for skeletal health in Bristol and Avon (COSHIBA)"],"prefix":"10.1093","volume":"27","author":[{"given":"Emma M","family":"Clark","sequence":"first","affiliation":[{"name":"Academic Rheumatology, Musculoskeletal Research Unit, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Gould","sequence":"additional","affiliation":[{"name":"Academic Rheumatology, Musculoskeletal Research Unit, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leigh","family":"Morrison","sequence":"additional","affiliation":[{"name":"Academic Rheumatology, Musculoskeletal Research Unit, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AE","family":"Ades","sequence":"additional","affiliation":[{"name":"School of Social and Community Medicine, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Dieppe","sequence":"additional","affiliation":[{"name":"Peninsular College of Medicine and Dentistry, University of Plymouth, Plymouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon H","family":"Tobias","sequence":"additional","affiliation":[{"name":"Academic Rheumatology, Musculoskeletal Research Unit, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2011,11,23]]},"reference":[{"issue":"7","key":"2024020318243831100_bib1","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1002\/jbmr.5650110719","article-title":"The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study","volume":"11","author":"O'Neill","year":"1996","journal-title":"J Bone Miner Res."},{"issue":"11","key":"2024020318243831100_bib2","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1097\/00005650-199711000-00002","article-title":"Modeling valuations for EuroQol health states","volume":"35","author":"Dolan","year":"1997","journal-title":"Med Care."},{"key":"2024020318243831100_bib3","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/s001980050063","article-title":"Reduced pulmonary function in patients with spinal osteoporotic fractures","volume":"8","author":"Schlaich","year":"1998","journal-title":"Osteoporosis Int."},{"issue":"3","key":"2024020318243831100_bib4","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1007\/s001980050067","article-title":"Mortality associated with vertebral deformity in men and women: results from the European Prospective Osteoporosis Study (EPOS)","volume":"8","author":"Ismail","year":"1998","journal-title":"Osteoporos Int."},{"issue":"4","key":"2024020318243831100_bib5","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s001980200033","article-title":"Direct medical costs attributable to osteoporotic fractures","volume":"13","author":"Gabriel","year":"2002","journal-title":"Osteoporos Int."},{"issue":"5","key":"2024020318243831100_bib6","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1080\/17453670510041745","article-title":"Direct medical costs of traumatic thoracolumbar spine fractures","volume":"76","author":"van der Roer","year":"2005","journal-title":"Acta Orthop."},{"issue":"12","key":"2024020318243831100_bib7","doi-asserted-by":"crossref","first-page":"1982","DOI":"10.1359\/jbmr.040901","article-title":"When should the doctor order a spine X-ray? 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