Underutilization of osteoporosis screening in eligible men: Analysis of the U.S. national ambulatory medical care survey.
TL;DR
DXA ordering during U.S. primary care visits appears markedly low among men at risk for osteoporosis, representing a missed opportunity for early detection and fracture prevention.
Abstract
Background
Clinical practice guidelines from the Endocrine Society recommend osteoporosis screening in high-risk men; however, the extent of implementation in clinical practice is unclear.
Methods
We conducted a cross-sectional study using data from the National Ambulatory Medical Care Survey (NAMCS) from 2012 to 2019. We evaluated ordering patterns for dual-energy X-ray absorptiometry (DXA) during primary care visits among patients eligible for screening under the Endocrine Society Clinical Practice Guideline, based on guideline-concordant criteria operationalized using available NAMCS variables. We included men aged≥70 years and women aged≥65 years. Also, men aged 50-69 years and women aged 50-64 years with additional risk factors, such as body mass index<18.5 kg/m2, tobacco use, alcohol use disorder, or glucocorticoid therapy. We excluded visits among patients with osteoporosis. The trend in DXA screening was examined using multivariable, survey-weighted log-binomial regression models, and results are presented as relative risks (RR) with 95% confidence intervals (CI) and two-sided p-values.
Results
We identified 4573 visits for eligible individuals. The median age was 72 years; 61% were women, 74% were non-Hispanic White, and 11% were non-Hispanic Black. The likelihood of DXA ordering was approximately 100 times less likely at visits among men suggested for screening (0.04%; 95% CI 0.00%-0.15%) than among women suggested for screening (5.1%; 95% CI 3.5%-7.1%). We observed no significant change in DXA ordering across survey years (p = 0.48). DXA ordering among women peaked at 6.9% in 2014-2016, while rates among men remained below 0.1%.
Conclusion
DXA ordering during U.S. primary care visits appears markedly low among men at risk for osteoporosis, representing a missed opportunity for early detection and fracture prevention.