Osteoporosis Screening in High-Risk Men Save

There is limited evidence supporting osteoporosis screening in men, especially in primary care.

This study tested the impact of a centralized, remote bone health service (BHS) on screening, treatment, adherence, and bone density in older men with fracture risk factors. The randomized clinical trial involved 39 primary care teams in 2 Veterans Affairs (VA) Health Systems that included 3112 male veterans aged 65 to 85 years who had at least 1 fracture risk factor but had no prior fractures. 

BHS screening included dual-energy x-ray absorptiometry (DXA) scan, followed by an electronic consult to their primary care clinician, nurse care manager and PCP team. 

Participants were older (mean 73.3 years); mostly black [40%] or white [56%]; with half (49%) of the BHS group screened vs 2.3% of the usual care group (P < .001). More than half of those screened (51%) had osteopenia or osteoporosis. 

Over 84% of the BHS group initiated osteoporosis treatment and achieved high levels of adherence and high persistence to OP therapies over 2 years of follow-up. There was less mean femoral neck T-score change over 2 years in the BHS vs usual care groups (−0.55 vs −0.70, P = .04).

Facilitation of bone screening in high risk men (BHS model) resulted in significantly better outcomes compared with usual care, with a higher average femoral neck bone density at 2 years. The approach of using fracture risk factors to select men for screening yields a comparable proportion of men diagnosed with osteopenia or osteoporosis with screening of women 65 years or older.