Benefits, Harms, and Costs of Osteoporosis Screening in Male Veterans
Technical Report,30 Sep 2012,29 Sep 2017
Institute for Medical Research, Inc. Durham United States
Pagination or Media Count:
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 n2,539,812 were included. Men receiving DXA were 13 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, 0.66-0.89glucocorticoids 0.77, 0.72-0.84 age 80 years 0.85, 0.81-0.90 one or more VA guideline risk factors 0.91, 0.87-0.95and 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.
- Medicine and Medical Research