Osteoporosis Screening in Primary Care: Early Implementation Gaps Following the 2023 Saudi Guideline Update

Area of Science:

• Primary Care Medicine
• Geriatrics
• Bone Health

Background:

• Osteoporosis screening guidelines aim to prevent fractures in at-risk populations.
• The 2023 Saudi Osteoporosis Society (SOS) guideline recommends universal screening for adults aged 60 and older.
• Effective implementation of screening guidelines in primary care is crucial for public health.

Purpose of the Study:

• To evaluate adherence to the 2023 SOS osteoporosis screening guideline in adults aged 60+.
• To identify factors associated with ordering bone mineral density (BMD) tests in primary care.

Main Methods:

• Retrospective electronic medical record (EMR) study of 2186 patients aged 60+.
• Data collected from a university-affiliated primary care center between May 2023 and December 2025.
• Multivariable logistic regression analysis to determine predictors of BMD ordering.

Main Results:

• BMD screening was ordered for 19.7% of eligible patients; only 4.1% completed testing.
• Factors associated with BMD ordering included female sex (aOR 5.26), history of osteoporosis (aOR 139.40), and history of fracture (aOR 10.35).
• Female physician sex was also associated with ordering (aOR 1.50).

Conclusions:

• Adherence to universal osteoporosis screening guidelines in primary care remains low.
• A significant gap exists between BMD test ordering and completion, suggesting implementation barriers.
• Further strategies are needed to improve osteoporosis screening rates and reduce fracture risk in older adults.