Benefits, Harms, and Costs of Osteoporosis Screening in Male Veterans

Abstract

This is a propensity score matched observational study using CMS and VA data from January 1, 2000-December 31,mean follow-up 4.7 years. Men receiving VA primary care aged 65-99 without prior fracture (n=2,539,812) were included. Men receiving DXA were 1:3 matched with untested controls by propensity scores indicating the probability of DXA testing within the next year. Time to first clinical fracture was the primary outcome. Co-morbidities, demographics, medications, DXA results, and osteoporosis treatment were defined using administrative data and natural language processing. Landmark analysis with competing risk compared time to fracture. During follow-up of 183,943 men tested with DXA and475,449 controls, 9.4 fractured and 20.6 died. DXA testing overall was not associated with a decrease in fractures; conclusions are limited by unmeasured confounders and low medication initiation and adherence in those meeting treatment thresholds (12 of follow-up time). Mortality was 21 lower in DXA tested men, also likely related to unmeasured confounders and selection bias. In contrast, DXA testing in pre-specified subgroups was associated with lower risk of fracture compared to the overall DXA population: androgen deprivation therapy (HR 0.77, 0.66-0.89);glucocorticoids (0.77, 0.72-0.84); age > 80 years (0.85, 0.81-0.90); one or more VA guideline risk factors (0.91, 0.87-0.95);and high FRAX- BMI (0.90, 0.86-0.95). Total costs were slightly higher for DXA treated men than untested men; cost effectiveness analysis was not completed due to the overall lack of benefit of DXA testing. We conclude that current VADXA testing practices are ineffective overall; interventions to improve treatment adherence are needed. Targeted DXA testing of higher risk men was associated with lower fracture risk.

Open PDF

Document Details

Document Type
Technical Report
Publication Date
Dec 01, 2017
Accession Number
AD1053962

Entities

People

  • Cathleen S. Colon-emeric
  • Megan Pearson

Organizations

  • Institute for Medical Research

Tags

Communities of Interest

  • Biomedical

DTIC Thesaurus Topics

  • Bone Diseases
  • Bone Fractures
  • Colon Cancer
  • Databases
  • Demography
  • Enzyme Inhibitors
  • Health Services
  • Information Science
  • Lung Diseases
  • Medical Personnel
  • Natural Language Processing
  • Osteoporosis
  • Risk Analysis
  • Vascular Diseases

Fields of Study

  • Medicine

Readers

  • Neurotrauma and Rehabilitation Medicine.
  • Women's Health and Cancer Risk Research: African American Women and Pregnancy Outcomes.

Technology Areas

  • AI & ML