{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T05:16:20Z","timestamp":1765516580062,"version":"3.48.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Osteoporosis (OP) is the gradual loss of bone mineral density (BMD), predisposing to fragility fractures. It can be the result of aging or menopause in primary OP or other diseases and medications in secondary OP. The gold standard diagnostic tool for low BMD is represented by dual-energy X-ray absorptiometry (DXA), which has been included among the Essential Assistance Levels (EALs) in Italy for adequate prescription. This observational study based on administrative data evaluates whether the EALs are designed to predict OP (designed to include OP screening), with subsequent BMD-DXA evaluation in Italian men and women. The SIMON database was used to select women and men scheduled to undergo BMD-DXA according to EALs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      BMD was evaluated in 18,087 subjects [Male (M): Female (F) 889: 17198; mean age 71.3 \u00b1 9.3 years; body mass index (BMI): 26.9 \u00b1 4.5 Kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ] for primary OP and in 6,503 subjects (M: F 649: 5854; mean age 70.5 \u00b1 9.4 years; BMI: 25.4 \u00b1 4.8 Kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) for secondary OP, both suspected on the basis of EALs. Primary OP was confirmed by DXA in 13,759 (80.0%; mean age 71.9 \u00b1 9.2 years; BMI: 26.5 \u00b1 4.8 Kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) women and in 551 men (62.0%; mean age 69.3 \u00b1 9.4 years; BMI: 26.5 \u00b1 4.8 Kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). Secondary OP was confirmed by DXA in 4,683 women (80.0%; mean age 70.7 \u00b1 8.9 years; BMI: 25.3 \u00b1 5.0 Kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) and in 514 men (79.2%; mean age 69.7 \u00b1 9.4 years; BMI: 26.3 \u00b1 5.3 Kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). The positive predictive values of EALs for OP were higher among women for primary OP than men and similar in both genders without any significant difference in secondary OP.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Italian EAL are a useful diagnostic tool for primary of OP in both sexes, with significant gender dimorphism evident in secondary OP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1689549","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T05:15:00Z","timestamp":1765516500000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Bone mineral density assessment according to Italian essential assistance levels: a positive predictive value analysis based on administrative data"],"prefix":"10.3389","volume":"16","author":[{"given":"Veronica","family":"Abate","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita","family":"Vergatti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guido","family":"Cavati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Magelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfonso","family":"Varriale","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Merlotti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianpaolo","family":"De Filippo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaetano","family":"Piccinocchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lanfranco","family":"D\u2019Elia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Gennari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domenico","family":"Rendina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1007\/s43465-023-01058-3","article-title":"Classification of osteoporosis","volume":"57","author":"Amarnath","year":"2023","journal-title":"Indian J Orthop"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2007.11.001","article-title":"A reference standard for the description of osteoporosis","volume":"42","author":"Kanis","year":"2008","journal-title":"Bone"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-006-0172-4","article-title":"An estimate of the worldwide prevalence and disability associated with osteoporotic fractures","volume":"17","author":"Johnell","year":"2006","journal-title":"Osteoporosis int: J estab as result coop bet Eur Found Osteoporosis Natl Osteoporosis Found USA"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.34171\/mjiri.34.154","article-title":"Economic burden of osteoporosis in the world: A systematic review","volume":"34","author":"Rashki Kemmak","year":"2020","journal-title":"Med J Islam Repub Iran"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/pl00004148","article-title":"World-wide projections for hip fracture","volume":"7","author":"Gullberg","year":"1997","journal-title":"Osteoporosis int: J estab as result coop bet Eur Found Osteoporosis Natl Osteoporosis Found USA"},{"key":"B6","unstructured":"Epidemiology, burden, and treatment of osteoporosis in Italy\n          \n          2021"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/s8756-3282(03)00061-9","article-title":"The components of excess mortality after hip fracture","volume":"32","author":"Kanis","year":"2003","journal-title":"Bone"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.6.785","article-title":"Osteoporosis prevention, diagnosis, and therapy","volume":"285","year":"2001","journal-title":"JAMA"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1359\/JBMR.050304","article-title":"Predictive value of BMD for hip and other fractures","volume":"20","author":"Johnell","year":"2005","journal-title":"J Bone Miner Res"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.312.7041.1254","article-title":"Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures","volume":"312","author":"Marshall","year":"1996","journal-title":"BMJ"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bdj.2017.459","article-title":"The healthcare system and the provision of oral healthcare in European Union member states. Part 8: Italy","volume":"222","author":"Bindi","year":"2017","journal-title":"Br Dent J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1007\/s11739-018-1874-2","article-title":"Guidelines for the management of osteoporosis and fragility fractures","volume":"14","author":"Nuti","year":"2019","journal-title":"Internal Emergency Med"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-023-02211-3","article-title":"Role of active and environmental tobacco smoke on susceptibility to osteoporosis in women undergoing dual-X-ray absorptiometry","volume":"47","author":"Vergatti","year":"2024","journal-title":"J Endocrinol Invest"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-020-01428-w","article-title":"Metabolic syndrome is associated to an increased risk of low bone mineral density in free-living women with suspected osteoporosis","volume":"44","author":"Rendina","year":"2021","journal-title":"J Endocrinol Invest"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s00223-020-00737-9","article-title":"Osteoporosis is a predictive factor for nephrolithiasis in an adult free-living caucasian population from southern Italy: A longitudinal retrospective study based on a general practice database","volume":"107","author":"Rendina","year":"2020","journal-title":"Calcif Tissue Int"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-021-01638-w","article-title":"Metabolic syndrome is not associated to an increased risk of low bone mineral density in men at risk for osteoporosis","volume":"45","author":"Rendina","year":"2022","journal-title":"J Endocrinol Invest"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-024-02402-6","article-title":"Smoking habits and osteoporosis in community-dwelling men subjected to dual-X-ray absorptiometry: a cross-sectional study","volume":"47","author":"Vergatti","year":"2024","journal-title":"J Endocrinol Invest"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2013.12.006","article-title":"GFR estimation: from physiology to public health","volume":"63","author":"Levey","year":"2014","journal-title":"Am J Kidney Dis"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.5650090802","article-title":"The diagnosis of osteoporosis","volume":"9","author":"Kanis","year":"1994","journal-title":"J Bone Miner Res"},{"key":"B20","doi-asserted-by":"crossref","unstructured":"Fragility fractures\n          \n          2024","DOI":"10.1007\/978-981-99-9696-4_7"},{"key":"B21","unstructured":"Fragility fractures"},{"key":"B22","unstructured":"ISCD adult position\n          \n          2023"},{"key":"B23","article-title":"Linee Guida per la Diagnosi, Prevenzione e Terapia dell'Osteoporosi [Guidelines for the diagnosis, prevention and treatment of osteoporosis","year":"2013","journal-title":"Ital Osteoporosis Min Metabol Skeletal Dis Soc Minerva"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1007\/s11914-013-0164-1","article-title":"Idiopathic osteoporosis in men","volume":"11","author":"Gennari","year":"2013","journal-title":"Curr Osteoporos Rep"},{"key":"B25","unstructured":"Geneva, Switzerland\n          World Health Organization\n          Prevention and management of osteoporosis: report of a WHO scientific group\n          \n          2003"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/s0969-8043(98)00026-8","article-title":"Radiation exposure in bone mineral density assessment","volume":"50","author":"Njeh","year":"1999","journal-title":"Appl Radiat Isot"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.221219","article-title":"Recommendations on screening for primary prevention of fragility fractures","volume":"195","author":"Th\u00e9riault","year":"2023","journal-title":"CMAJ"},{"key":"B28","unstructured":""},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-024-01094-9","article-title":"Evidence-Based Guideline for the management of osteoporosis in men","volume":"20","author":"Fuggle","year":"2024","journal-title":"Nat Rev Rheumatol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-021-01792-w","article-title":"Gender disparities in osteoporosis screening and management among older adults","volume":"38","author":"Ramachandran","year":"2021","journal-title":"Adv Ther"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2025.4150","article-title":"Remote\u00a0bone health service for osteoporosis screening in high-risk men: A cluster randomized clinical trial","volume":"185","author":"Col\u00f3n-Emeric","year":"2025","journal-title":"JAMA Internal Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1186\/s12913-020-05207-4","article-title":"Comprehensive review of ICD-9 code accuracies to measure multimorbidity in administrative data","volume":"20","author":"Wei","year":"2020","journal-title":"BMC Health Serv Res"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1689549\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T05:15:01Z","timestamp":1765516501000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1689549\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,12]]},"references-count":32,"alternative-id":["10.3389\/fendo.2025.1689549"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1689549","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,12]]},"article-number":"1689549"}}