This systematic review and meta-analysis showed a significant reduction of (major) osteoporotic fractures and hip fractures after screening using fracture risk assessment and bone densitometry compared with usual care. The results indicate that screening is effective for fracture risk reduction, especially hip fractures. To perform a systematic review and meta-analysis of population screening for high fracture risk on fracture prevention compared with usual care. MEDLINE and Embase were searched for studies published until June 20th 2019. Randomized studies were selected that screened for high fracture risk using at least bone densitometry, screened in a general population, provided subsequent treatment with anti-osteoporosis medication, had a usual care group as comparator, and had at least one fracture-related outcome (all fractures, (major) osteoporotic fractures, or hip fractures). The primary assessment was the hazard ratio (HR) for fracture-related outcomes. All-cause mortality was a secondary outcome. Random-effects models were used to estimate pooled HRs. We identified 1186 potentially eligible articles and included three randomized studies: the ROSE study, the SCOOP study, and the SOS with a total number of N = 42,009 participants. Respectively, 11%, 15%, and 18% of the participants in the intervention group started medication. Meta-analysis showed a statistically significant and clinically relevant reduction of osteoporotic fractures (HR = 0.95, 95% confidence interval (CI) = 0.89–1.00), major osteoporotic fractures (HR = 0.91; 95%CI = 0.84–0.98), and hip fractures (HR = 0.80; 95%CI = 0.71–0.91), but no reduction of all fractures (HR = 0.95; 95%CI = 0.89–1.02). The pooled HR for the secondary outcome all-cause mortality was 1.04 (95% CI = 0.95–1.14). Numbers needed to screen to prevent one fracture were 247 and 272 for osteoporotic fractures and hip fractures, respectively (corresponding to 113 and 124 performed bone densitometry examinations, and 25 and 28 persons being treated). This meta-analysis showed that population screening is effective to reduce osteoporotic fractures and hip fractures. Implementation of screening in older women should be considered as serious option to prevent osteoporotic fractures, especially hip fractures.

中文翻译：

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通过筛查高骨折风险来预防骨折：系统评价和荟萃分析

这项系统的回顾和荟萃分析显示，与常规治疗相比，使用骨折风险评估和骨密度测定法筛查后，（重大）骨质疏松性骨折和髋部骨折明显减少。结果表明，筛查可有效降低骨折风险，尤其是髋部骨折。与常规护理相比，对骨折预防的高骨折风险进行人群筛查的系统评价和荟萃分析。检索MEDLINE和Embase直至2019年6月20日发表的研究。选择随机研究，至少使用骨密度测定法筛查高骨折风险，并在普通人群中进行筛查，并提供随后的抗骨质疏松药物治疗，并按常规护理。比较者，并且至少有一项与骨折相关的结果（所有骨折，（主要）骨质疏松性骨折或髋部骨折）。首要评估是骨折相关结局的危险比（HR）。全因死亡率是次要结果。随机效应模型用于估计合并的HR。我们确定了1186篇可能符合条件的文章，其中包括三项随机研究：ROSE研究，SCOOP研究和SOS，其总数为ñ= 42,009名参与者。干预组中分别有11％，15％和18％的参与者开始服药。荟萃分析显示，骨质疏松性骨折（HR = 0.95，95％置信区间（CI）= 0.89–1.00），主要骨质疏松性骨折（HR = 0.91； 95％CI = 0.84–0.98）在统计学上和临床上均有相关性降低髋部骨折（HR = 0.80； 95％CI = 0.71-0.91），但没有减少所有骨折（HR = 0.95； 95％CI = 0.89–1.02）。次要结果全因死亡率的合并HR为1.04（95％CI = 0.95-1.14）。骨质疏松性骨折和髋部骨折的筛查数量分别为247和272（分别进行了113和124次骨密度检查，分别有25和28人接受了检查）。这项荟萃分析表明，人群筛查可有效减少骨质疏松性骨折和髋部骨折。在老年妇女中进行筛查应被视为预防骨质疏松性骨折（尤其是髋部骨折）的严重选择。