Handle with care

Community based screening for frailty in older people is attracting a degree of attention in the literature. A review of how frailty is recognised and managed in primary care is a timely addition. The Journal of the American Geriatrics Society publishes a panel review of screening older people for particular conditions, as represented in a raft of guidelines. They find that screening for insufficient physical activity, cardiovascular risk factors and smoking are appropriate in aiming to prevent functional decline. A systematic review of screening tools for use in primary health care identifies the Tilburg Frailty Indicator and the SHARE Frailty Index as the most appropriate. A prospective study in a community context looks at Tilburg alongside the Gronigen Frailty Indicator and the Sherbrooke Postal Questionnaire.

Clean break

Fragility fractures are often linked to osteoporosis. NICE has just opened consultation on draft guidance to assess the risk of fragility fractures in adults. Responses are due in by 8 March. There's a comparison of UK case-finding strategies for management of hip fractures in the latest issue of Osteoporosis International, looking at the Royal College of Physicians strategy and the newer National Osteoporosis Guideline Group approach. Some more detail is provided on the SCOOP trial of community based screening for osteoporosis. Finally, Value in Health offers a systematic review of cost-effectiveness in strategies for selecting and treating people at risk of osteoporosis and osteopenia.

False positives

The debate over the value of the UK Breast Cancer Screening programme reached a wider audience today, as the media picked up Mike Richards' announcement in the BMJ of an independent review. A recent Cochrane review has suggested that screening for breast cancer "seems likely to reduce breast cancer mortality" but the level of reduction is small. Moreover the extent of disbenefit from unnecessary treatment for misdiagnosed healthy women, along with psychological distress, means that it is "not clear whether screening does more good than harm."