LBSAT139 Osteoporosis Screening In Men As Per Endocrine Society Clinical Practice Guidelines: A Cross-sectional Study
Authors: Pradeep Pallavi , Obeid Michele , DeCarlo Kristen 
Published: November 2022

Abstract

Introduction
With the aging of the population, osteoporosis in men is a significant public health problem. Both hip and vertebral fractures are associated with increased mortality in men, as compared to women. One out of every five men experiences fragility fractures at least once in their lifetime. Declining sex steroid levels and bioavailable estradiol levels contributes to age-related bone loss in men. The objective of this study was to identify the underdiagnosis and the lack of guideline-based screening for osteoporosis in men. Method: Endocrine Society Clinical Practice Guidelines published in June 2012 recommends screening for osteoporosis in all men aged ≥70y, and all men aged between 50-69y who have risk factors including delayed puberty, hypogonadism, hyperparathyroidism, hyperthyroidism, chronic obstructive pulmonary disease; drugs such as glucocorticoids or GnRH agonists; life choices such as alcohol abuse or smoking; or other causes of secondary osteoporosis, using a dual-energy x-ray absorptiometry (DXA) of the spine and hip. The National Osteoporosis Foundation has similar recommendations. | Using a cross-sectional study design, charts of male patients eligible for osteoporosis screening, between the period of September 2020 to December 2021, were reviewed. Patients seen in the internal medicine residents’ clinic, family medicine residents’ clinic and endocrinology clinic were included in the study.

Results
A total of 90 out of the 1120 male patients aged ≥70y had ever undergone a DXA scan. Of these 90 patients, on reviewing their problem list from the electronic health record, 15 had osteoporosis listed and 9 had fragility fracture/compression fracture/fracture listed. Of the 135 patients aged ≥50y with ho HIV, only 21 received a DXA scan. Additionally, it was observed that only 20% (23/120) of the patients on testosterone therapy were screened for osteoporosis. As compared to this, almost 40% (1012 out of 2479) of all women aged ≥65y received screening DXA scan.

Conclusion
This project highlighted the inconsistencies in ordering screening DXA scans for male patients at risk for osteoporosis. Fewer than 10% of the at-risk males had a DXA. Additionally, 10% of the patients who underwent DXA had already suffered from a fracture, further emphasizing the burden of this disease. Although osteoporosis is appreciated in post-menopausal women, we must not overlook our male patients, who have 2-3 times higher morbidity and mortality associated with a hip fracture. Based on this data, we plan to initiate a quality improvement project with an aim to improve guideline directed screening for osteoporosis. Enhanced DXA screening for at risk patients will not only reduce rates of fragility fracture but will also help reduce healthcare cost. For a sustainable and broader impact, we are working further on EPIC Best Practice Alert to prompt providers to order DXA scans for these patients.
Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.