Risk-Based, Centralized Screening may Improve Osteoporosis Care in Men: JAMA
Researchers have found in a new cluster randomized trial that selecting men for osteoporosis screening by fracture risk factors and using a centralized screening model enhanced screening rates, treatment initiation, and medication adherence. The findings, published in JAMA, highlight a potential shift in how osteoporosis prevention and care can be effectively implemented in men, a group often underdiagnosed and undertreated for bone health.
The study included older male participants who were identified through primary care practices. Rather than relying solely on opportunistic screening during clinic visits, the intervention used a centralized process that flagged high-risk individuals based on established fracture risk profiles. These men were then invited for dual-energy X-ray absorptiometry (DXA) testing and, if indicated, were offered treatment and follow-up support.
Compared to usual care, the risk-based centralized strategy led to significantly higher screening completion rates. Importantly, it also increased the number of men who started pharmacologic therapy for osteoporosis, with better persistence and adherence to prescribed medications. This is particularly relevant given that men tend to present later in the course of osteoporosis, often after experiencing a fragility fracture, leading to worse outcomes compared to women.
The authors suggest that integrating centralized screening pathways within health systems may reduce the burden on primary care providers, while ensuring that men at greatest risk are not overlooked. Such approaches could ultimately reduce fracture incidence, health care costs, and disability related to osteoporosis.
Further research is needed to evaluate scalability across diverse populations and health systems, as well as to assess long-term impacts on fracture prevention and mortality. Still, the results add to growing evidence that proactive, risk-based, and system-level interventions can close existing gaps in men’s osteoporosis care.
Keywords: osteoporosis, men’s health, fracture risk, DXA screening, cluster randomized trial, JAMA, centralized care, pharmacologic therapy, adherence, bone health
