Thousands of women are to take part in a screening trial in Birmingham that could pave the way to major changes in the diagnosis and management of osteoporosis.
More than 11,000 women from across England will be recruited for the Screening Of Older women for Prevention of fracture (Scoop) study which begins in January.
The £4.13 million seven-year trial funded by the Medical Research Council and Arthritis Research Campaign is one of the largest studies of osteoporosis ever undertaken in the world.
Its aim is to test the effectiveness of individual screening for the brittle bone disease most commonly suffered by women after the menopause.
Osteoporosis causes around 200,000 bone fractures each year in the UK, including 86,000 debilitating hip fractures. The disease can have an enormous impact on quality of life and costs health and social services around £1.7 billion per year. Currently most patients are diagnosed with the condition and given treatment only after they have had a fracture.
In some cases, these breaks are life-threatening, and around 20 per cent of those who suffer a hip fracture die within a year.
Experts agree that early diagnosis and prevention could have huge benefits. However, at present there is no proven screening system in the UK.
The Scoop study is being led by scientists from the University of Southampton working with colleagues from the universities of Birmingham, East Anglia, Bristol, Manchester, York and Sheffield.
Women aged 70 to 85 are to be recruited for the trial from communities close to the seven universities.
Half the participants will be placed in a "screening group" and have their fracture susceptibility assessed using a risk factor questionnaire developed by the World Health Organisation (WHO).
Women taking the screening test will be asked about their personal and family medical history and lifestyle.
From their answers, researchers will then evaluate their risk of suffering bone fractures over the next 10 years.
Previous osteoporotic fractures or a history of the problem in the family, use of steroid drugs, habitual smoking and heavy alcohol consumption would all suggest someone at high risk. Those falling into the "high risk" category will be offered bone scans, which can spot clinical signs of osteoporosis.
If necessary, they will be given bisphosphonate drugs which prevent bone thinning and can reduce the risk of fracture by 50 per cent.
In the other half of the study participants will go into a "control group" receiving "usual care".
This basically leaves it up to GPs to spot women likely to have brittle bones, an approach which currently identifies only five per cent to 10 per cent of patients who could benefit from treatment. Professor Cyrus Cooper, director of the Medical Research Council Epidemiology Resource Centre based at the University of Southampton, said: "Osteoporosis is usually diagnosed using a DXA bone density scan whose images allow the strength of bone to be assessed.
"At the moment, women offered a scan are mainly those who have already suffered a fracture or are suspected by their GP to be at high risk.
"Given the magnitude of the public health problem, and the novel WHO approach to evaluating individual risk, a widespread and systematic screening programme could cost-effectively prevent fractures."
Claire Severgnini, chief executive of the National Osteoporosis Society (NOS), said: "The NOS is extremely pleased to see that research into osteoporosis is becoming prioritised.
"This study is likely to have a huge impact for those who have osteoporosis as well as for future generations."