Abstract
Evaluation of the effectiveness of bone mineral density (BMD) testing within national health screening programs should consider country-specific contexts when applied to asymptomatic populations. BMD testing at age 66 in women was associated with increased osteoporosis-related medical visit and a reduction of subsequent fracture incidence. These findings suggest potential benefits of population-based screening with BMD testing. PURPOSE: Early detection of osteoporosis through bone mineral density (BMD) testing may help prevent future fractures. This study aimed to investigate the impact of incorporating BMD testing in South Korea's national health screening program on outpatient visits with an osteoporosis diagnosis and fractures. METHODS: We used data from the Korean National Health Insurance Service-Senior Cohort (2002-2019) and included only women aged 66 years, as specified by national screening policy, without prior osteoporosis who underwent national health screening between 2004 and 2009. Screening periods were categorized by the inclusion of BMD testing. Outcomes included osteoporosis-related medical visits within two years and incident osteoporotic fractures. Multivariable logistic regression and Cox proportional hazards regression were used to examine osteoporosis detection and fracture risk, respectively. RESULTS: Among the 24,895 women screened, 24.7% had osteoporosis-related medical visits within two years, and 21.5% experienced fractures during follow-up. Compared to the period without BMD testing, the inclusion of BMD testing was associated with a 52% increase in osteoporosis-related medical visits (odds ratio: 1.52, 95% confidence interval [CI]: 1.42-1.62), whereas the risk of subsequent fractures was reduced by 9% (hazard ratio: 0.91, 95% CI: 0.86-0.96). These associations were more pronounced among those with low body mass index and significant during the 5-10 years of follow-up for hip and vertebral fractures. CONCLUSION: Nationwide implementation of BMD testing increased the medical visits for osteoporosis and was associated with a reduction in subsequent fractures. To further enhance the effectiveness of the screening program, improved post-screening management is needed.