# Models of Primary Osteoporosis Screening in Male Veterans

> **NIH VA I01** · DURHAM VA MEDICAL CENTER · 2022 · —

## Abstract

Current VA Undersecretary Guidelines recommend primary osteoporosis screening for at-risk men to
reduce the morbidity, mortality, and cost associated with osteoporotic fractures. However, our recent work in a
national Veterans Health Administration cohort of over 4,000,000 men demonstrated that primary osteoporosis
screening as it is currently operationalized does not benefit most older Veterans due to inefficient targeting and
low subsequent treatment and adherence rates.
 The overall objective of this application is to determine whether 2 new models of primary osteoporosis
screening reduce fracture risk factors in older male Veterans compared to usual care. We propose a group
randomized trial of PACTs to: 1) usual care; 2) a PACT practice management model with tools and processes
to facilitate screening and adherence activities by PACT providers; 3) a Bone Health Service (BHS) screening
model in which screening and adherence activities are managed by a centralized expert team. Both new
models include a robust adherence component utilizing evidence-based methods appropriate for the model
structure. The specific aims are to: 1) compare the impact of these 2 new screening models vs. usual care on
patient-level outcomes strongly associated with fracture rates (eligible proportion screened, proportion
meeting treatment criteria who receive osteoporosis medications, and medication adherence); 2) determine the
impact of the 2 new screening models on provider and facility-level outcomes including change in DXA
volume, change in metabolic bone disease clinic volume, and PACT provider time and satisfaction; and 3)
determine the impact of the 2 new screening models on health system and policy outcomes (Markov
models of screening program cost per quality adjusted life year based on VA national fracture data, results
from aims 1 and 2, and published quality of life estimates).
 We propose a pragmatic group randomized trial of male Veterans aged 65-85 years meeting current VA
Undersecretary primary osteoporosis screening guidelines. PACT teams will be randomized into 3 intervention
groups: usual care (control); a PACT practice management model; or a centralized Bone Health Service (BHS)
model. Outcomes for all eligible patients within randomized PACTs will be assessed by investigators masked
to group assignment via EMR at baseline and 2 years. Analyses will account for 3-levels of clustering and
relevant covariates. Expected results are the relative effectiveness and cost-effectiveness of 2 new models of
osteoporosis screening and adherence promotion. Next steps include dissemination of the preferred model to
a wider array of facilities via centralization of screening services (BHS) or Learning Collaborative with new
performance metrics and toolkits (PACT practice management).
 To our knowledge this would be the first randomized trial of osteoporosis screening in older men. This
application directly addresses HSR&D High Priority Research topics including imp...

## Key facts

- **NIH application ID:** 10308442
- **Project number:** 5I01HX002512-03
- **Recipient organization:** DURHAM VA MEDICAL CENTER
- **Principal Investigator:** CATHLEEN S COLON-EMERIC
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-08-01 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10308442

## Citation

> US National Institutes of Health, RePORTER application 10308442, Models of Primary Osteoporosis Screening in Male Veterans (5I01HX002512-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10308442. Licensed CC0.

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