Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Study: Veterans Affairs DXA Testing Ineffective

Mayo Clin Proc; 2018 Dec; Colón-Emeric, et al

Current Veterans Affairs (VA) dual-energy x-ray absorptiometry (DXA) testing practices are ineffective overall, a recent study found, and interventions to improve treatment adherence are needed. Researchers conducted a propensity score-matched observational study using Centers for Medicare and Medicaid Services and VA data from January 1, 2000, through December 31, 2010, with a mean follow-up time of 4.7 years. Men receiving VA primary care aged 65 to 99 years without a previous fracture (n=2,539,812) were included. They found:

  • During follow-up of 153,311 men tested by DXA and 390,158 controls, 56,083 (10.3%) had sustained a fracture and 111,774 (20.6%) died.
  • Overall, DXA testing 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).
  • In contrast, DXA testing in pre-specified subgroups was associated with a lower risk of fracture in comparison to the overall population who underwent DXA testing: androgen deprivation therapy, glucocorticoids, age ≥80 years, ≥1 VA guideline risk factors, and high Fracture Risk Assessment Tool using body mass index score.


Colón-Emeric CS, Pieper CF, Van Houtven CH, et al. Limited osteoporosis screening effectiveness due to low treatment rates in a national sample of older men. Mayo Clin Proc. 2018;93(12):1749–1759. doi:10.1016/j.mayocp.2018.06.024.