关键词：骨质疏松症；心血管疾病；成本
摘 要：Despite the large burden of osteoporotic fractures, their associated complications, and costs to military personnel and veterans, there is considerable controversy about how to screen for and treat osteoporosis in men. The recommendations of clinical practice guidelines vary in how to select men to be screened, and the United States Preventive Services Task Force recently found insufficient evidence to recommend screening and treatment of osteoporosis in men at all, citing a lack of studies measuring fracture outcomes. This project will develop a large database combining Veterans Affairs and Centers for Medicare and Medicaid Services (CMS) information on bone health risk factors and outcomes. We will use this database to determine the benefits of osteoporosis screening, including rates of fractures and mortality. We will quantify the harms of osteoporosis screening and treatment, including rare but important side effects such as heart disease, esophageal cancer, and atypical fractures. We will prospectively measure healthcare costs in the screened and unscreened individuals, and model the impact of different screening selection criteria on healthcare system costs. The goal is to develop evidence-based male osteoporosis screening recommendations that optimize benefits to patients, while minimizing harms and health system costs. This study will establish the largest male osteoporosis database in the United States, including over 5.5 million screened and unscreened individuals followed for up to 10 years; prior studies have included fewer than 6000 screened men. Our study team includes representatives from important stakeholder groups including VA Patient Care Services, Pharmacy Benefits Management, the Agency for Healthcare Research and Quality (AHRQ), and professional societies. Therefore, the results of this study will have a high impact on osteoporosis care for male veterans, and will inform healthcare policy nationally.