Remote Bone Health Service for Osteoporosis Screening in High-Risk Men: A Cluster Randomized Clinical Trial

Area of Science:

• Geriatric Medicine
• Public Health
• Clinical Trials

Background:

• Osteoporosis screening in men lacks robust evidence and efficient primary care models.
• There is a need for improved osteoporosis screening and treatment adherence in older men at risk for fracture.

Purpose of the Study:

• To evaluate the impact of a centralized, remote bone health service (BHS) on osteoporosis screening, treatment initiation, adherence, and bone density in older men with fracture risk factors.

Main Methods:

• A cluster randomized clinical trial involving 39 primary care teams across 2 Veterans Affairs Health Systems.
• 3112 male veterans aged 65-85 years with at least one fracture risk factor but no prior fractures were included.
• The intervention group received a remote BHS including DXA screening, electronic consults, and nurse care management; the control group received usual care and guidelines.

Main Results:

• Osteoporosis screening rates were significantly higher in the BHS group (49.2%) compared to usual care (2.3%).
• Over half of screened individuals had osteopenia or osteoporosis.
• The BHS group showed high rates of osteoporosis treatment initiation (84.4%), adherence (91.7% days covered), and persistence (mean 657 days).
• A trend favored the BHS group for femoral neck T-scores at 24 months.

Conclusions:

• A centralized, remote bone health service model effectively enhances osteoporosis screening, treatment, and adherence in at-risk older men.
• Screening based on clinical risk factors before fracture has a high yield.
• Further validation in diverse settings and longer follow-up are needed to assess fracture reduction.