Background/Purpose: There are known indications for osteoporosis screening in women. However, osteoporosis also occurs in men and fragility fractures are linked to increased morbidity and mortality. Organizations as the National Osteoporosis Foundation, International Society for Clinical Densitometry, Endocrine Society, American College of Preventive Medicine, American College of Physicians, and American College of Rheumatology recommend that men ≥ 70 years old need universal screening for osteoporosis by dual energy x-ray absorptiometry. However, we have observed this recommendation to be underutilized in our resident clinic. The aim of this quality improvement project was to increase the documentation of osteoporosis screening in males ≥70 years old in our resident clinic (Grand Strand Primary Care) from the baseline 4-month average of 0% to ≥10% during the time period November 2019-May 2020.

Methods: Internal medicine residents were sent an educational email about osteoporosis screening in men ≥70 years old on November 1, 2019. It included the indications for screening in men, specific test to order, suggested diagnosis codes, references from literature, and solicited feedback regarding concerns about the project or clarification. Also, males ≥ 70 years old who were seen in clinic between July 1 and November 1, 2019 had their clinic notes reviewed for whether plans for screening was documented in the chart. Each resident was provided a customized list of patients (who had at least one scheduled follow-up in the next six months) for whom documentation about screening was lacking. Lastly, paper flyers were displayed in the clinic workspace similarly to those of other preventative health/screening recommendations for other medical conditions. On May 1, 2020 (six months later), charts were reviewed to evaluate the documentation rate of osteoporosis screening during the period November 1, 2019-May 1, 2020.

Results: Between July 1 and November 1, 2019, a total of 62 males ≥70 years old were seen in clinic among 26 residents. None of these patients had initial documentation regarding osteoporosis screening. Six months after our interventions (i.e. email sent on November 1, 2020, paper flyers displayed in clinic workroom), results were as follows: 11 patients were lost to follow-up (including one death), and 51 patients were seen at least once but osteoporosis screening was still not documented/discussed.

Conclusion: Our project did not meet the goal screening rate of at least 10% at six months. The results were humbling in that despite osteoporosis screening being recommended in men ≥70 years old by several medical organizations, screening rates remain exceptionally low, if not utilized at all. Although it is difficult to extrapolate our results to a broader scale, the major obstacles to screening most likely are limited life expectancy, prioritization of patients’ other comorbidities, cost (i.e. lack of insurance coverage), or the perception that osteoporosis is a disease solely of women. Further discussion must be held to reevaluate whether this universal screening recommendation will still hold in the future, or whether it is rather a highly individualized decision best discussed between patient and physician.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/improving-osteoporosis-screening-in-men-at-a-resident-run-primary-care-clinic-a-quality-improvement-project/