MON-793 - Under-Utilization of Bone Density Screening in High-Risk Men: An Analysis of the National Ambulatory Medical Care Survey

Background: Men account for approximately 39% of osteoporotic fractures worldwide and experience higher mortality following major fragility fractures compared with women (1). Although the Endocrine Society suggests screening for osteoporosis in high-risk men (2), this condition remains underrecognized and undertreated (1-3).

Methods: We conducted a cross-sectional study using the National Ambulatory Medical Care Survey (NAMCS) from 2012–2019. We evaluated dual-energy X-ray absorptiometry (DXA) ordering during primary care visits among patients eligible for screening based upon suggestions from the Endocrine Society guidelines (2). We included men aged ≥70 years and women aged ≥65 years. For men aged 50–69 years and women aged 50–64 years to be included, they had to have additional risk factors such as low body mass index, current tobacco use, excessive alcohol intake, chronic obstructive pulmonary disease, or glucocorticoid therapy. To capture patients engaged in preventive care, we restricted the sample to visits for patients with no more than two preventive care encounters with a primary care clinician during the survey year, and we excluded visits related to injuries. We excluded visits among patients with an established history of osteoporosis. The final analytic sample included 4,573 visits. Associations were 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: The median age of patients was 72 years (interquartile range, 66–78 years), with 61% women, 74% being non-Hispanic White, and 11% non-Hispanic Black. Overall, DXA was ordered in 3.1% visits, 95% CI [2.2%, 4.3%]. Visits among men were substantially less likely than women to have a DXA ordered (0.04% vs 5.1%; unadjusted RR 0.01, 95% CI [0.00, 0.05]). We found 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: Despite the Endocrine Society’s screening suggestions, DXA remains markedly underutilized in U.S. primary care among men at risk for osteoporosis, representing a missed opportunity for early detection and fracture prevention.

References:
1. Björnsdottir, S., Clarke, B. L., Mannstadt, M. & Langdahl, B. L. Male osteoporosis-what are the causes, diagnostic challenges, and management. Best Pract. Res. Clin. Rheumatol. 36, 101766 (2022).
2. Watts, N. B. et al. Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 97, 1802–1822 (2012).
3. Eastell, R. et al. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society* Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 104, 1595–1622 (2019).

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*