Effecacy of a population-based screening program for osteoporosis and high fracture risk in primary healthcare

Underutilization of osteoporosis screening in eligible men: Analysis of the U.S. national ambulatory medical care survey.

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.

Osteoporosis in internal medicine outpatients: Sex-specific disparities in prevalence, risk stratification, and treatment in a large cohort

Osteoporosis is a major health problem linked to population aging. Internal medicine outpatients often have multiple comorbidities and a high osteoporosis risk; however, osteoporosis prevalence and treatment rates remain unclear. We investigated osteoporosis prevalence and treatment rates in a large cohort of internal medicine outpatients. This single-center, cross-sectional study used baseline data from the ongoing JUSTICE-TOKYO prospective cohort study ( N  = 1,078) of Japanese internal medicine outpatients aged ≥ 65 years. Demographic and clinical characteristics, osteoporosis prevalence, treatment rates, and risk assessment (Osteoporosis Self-assessment Tool for Asians [OSTA]) were assessed. Student’s t-test was used for between-sex comparisons of continuous variables and Pearson’s chi-square test for comparisons of categorical variables. Multivariable logistic regression analysis was performed to identify factors independently associated with osteoporosis. After excluding missing data, 1,040 cases were analyzed. The mean age was 78.2 ± 6.1 years. Overall osteoporosis prevalence was 28.3%, and differed significantly between men (15.8%) and women (38.0%) ( p  < 0.001). The treatment rate was 29.3% among osteoporosis patients, with a significant difference between men (12.5%) and women (34.7%) ( p  < 0.001). In the primary multivariable model adjusted for age, sex, and body mass index (BMI), older age, female sex, and lower BMI were independently associated with osteoporosis. In an exploratory model additionally including grip strength, lower grip strength was independently associated with osteoporosis, whereas the association with female sex was attenuated after adjustment. In this cohort, osteoporosis was highly prevalent and substantially undertreated, particularly among men. Significant sex-specific disparities were observed in both osteoporosis prevalence and treatment rates.

Antiresorptive Use and Risk of Hip Fracture in Older Women with Osteoporosis: Findings from a Real-World National Database of 21,332 Women

Background: Evidence on the real-world effectiveness of antiresorptive therapy for hip fracture prevention in very old women remains limited. We aimed to assess the association between antiresorptive use and incident hip fracture among age ≥ 75 older women with osteoporosis. Methods: We conducted a population-based nested case–control study using the Base de Datos para la Investigación Farmacoepidemiológica en Ámbito Público (BIFAP), a Spanish research database. Women aged 75 years or older with osteoporosis and no previous antiresorptive use at cohort entry were followed from 2010 to 2022. Incident hip fracture cases were matched to risk-set controls by age, autonomous region, and calendar year of database registration. Antiresorptive exposure was classified as current, recent, past, or never use. Conditional logistic regression was used to estimate adjusted odds ratios (aORs) and confidence intervals. Results: The study included 2057 incident hip fracture cases and 19,275 matched controls. Compared with never users, current antiresorptive users had lower odds of hip fracture (aOR 0.76; 0.65–0.87), whereas past users had higher odds (aOR 1.91; 1.57–2.33). Ever use was not associated with hip fracture risk compared with never use (aOR 1.01; 0.90–1.13). Conclusions: In this real-world nested case–control study of women aged ≥75 years with osteoporosis, current antiresorptive use was associated with lower odds of hip fracture, whereas past use was associated with higher odds. Because treatment initiation, persistence, and discontinuation are strongly influenced by baseline fracture risk, osteoporosis severity, frailty, and clinical surveillance, these findings should be interpreted as associations rather than causal treatment effects.

High fracture risk in postmenopausal women established by FRAX, Garvan, and POL-RISK algorithms

The incidence and predictors of falling in older adults: the results of follow-up in Iranian multicenter osteoporosis study (IMOS).

Prevention of Fracture Risk among Older Long-term Care Residents: A Prospective Study from India

Older adults in long-term care (LTC) facilities are at high risk for fragility fractures due to bone loss, impaired mobility, cognitive decline and polypharmacy. Such fractures increase morbidity, mortality and healthcare costs. This prospective study evaluated the effectiveness of a multifaceted intervention programme for fracture prevention amongst older adults in LTC. A prospective, 24-month interventional study (January 2022–December 2023) was conducted in 10 LTC homes across three districts with 520 residents aged ≥65 years. Outcomes were compared with a matched historical control cohort drawn from the same LTC facilities during 2020–2022, using identical inclusion criteria and outcome definitions. The intervention included Vitamin D and calcium supplementation, structured exercise, medication review, fall prevention strategies and environmental modifications. Fracture incidence, fall rates and functional status were compared to a historical control. Hip and non-hip fractures decreased by 36% and 28%, respectively. Vitamin D supplementation improved serum 25(OH) D levels ( P < 0.01). Exercise enhanced balance and strength ( P < 0.05). Psychotropic use declined by 18% following polypharmacy review. Fall rates dropped by 31%. A comprehensive, multidisciplinary intervention significantly reduced fracture risk in LTC residents, supporting its broader implementation to improve musculoskeletal health and safety in geriatric care.