VHA Policy and Practice Support Age-Specific Osteoporosis Screening in Women

The VA Office of Inspector General (OIG) conducted a national review of the Veterans Health Administration (VHA) to assess the policy pertaining to osteoporosis screening and to determine osteoporosis screening rates in women patients enrolled in VHA primary care who are age 65 and older. Osteoporosis is a disease characterized by decreased bone mineral density (BMD) and bone quality, resulting in an increased risk of fractures.

VHA policy states that preventive care for women patients must include osteoporosis screening, and the OIG found that VHA osteoporosis screening practices generally align with United States Preventive Service Task Force recommendations. VHA offers BMD testing at most of its facilities and utilizes BMD testing in the community when not available at the facility or for otherwise eligible patients.

The OIG estimated that 87 percent of the review population completed BMD testing and 93 percent of the review population had or were offered BMD testing. OIG-estimated screening rates were higher than VHA-estimated screening rates, although different methodologies were used to determine screening rates. The OIG identified patients who were at risk for osteoporosis and fracture who were not offered BMD testing.

VHA implemented measures to improve osteoporosis screening, including introduction of a toolkit and a clinical reminder. Improvement in osteoporosis screening rates temporally correlated with the implementation of the clinical reminder. Clinical reminder use appeared to vary between facilities as the OIG observed that there were sites where none of the sampled patients had identified osteoporosis clinical reminder use after implementation of the clinical reminder.

The OIG recommended that the Under Secretary for Health work with the Women’s Program Office to gain an understanding of barriers to osteoporosis clinical reminder use and, based on results, implement action as needed.