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[Correspondence] A closer look at SCOOP: screening for fracture prevention – Authors’ reply

We agree with Mark Bolland and Andrew Grey that the SCOOP trial1 provides much-needed high-quality evidence for screening, but for high fracture risk rather than for osteoporosis. The observation that Fracture Risk Assessment Tool (FRAX) probabilities in women at high risk of hip fracture in the screening group tended to decrease with the addition of bone mineral density (BMD) is correct but not unexpected. The FRAX tool is calibrated to the epidemiology of hip fractures in whole populations, and because selected subgroups are likely to have health differences not captured by clinical fracture risk factors, this will lead to differences in predicted and observed outcomes within subgroups.