ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Bone Research
This article is part of the Research TopicRecent Advances in the Management of Osteoporosis: Prevention, Diagnosis and TreatmentView all 16 articles
Bone Mineral Density assessment according to Italian Essential Assistance Levels: a positive predictive value analysis based on administrative data
Provisionally accepted
Veronica Abate1*
Anita Vergatti1
Guido Cavati2
Simone Magelli1Alfonso Varriale1
Daniela Merlotti2
Gianpaolo De Filippo3Gaetano Piccinocchi4
Lanfranco D'Elia1
Luigi Gennari2
Domenico Rendina1- 1Universita degli Studi di Napoli Federico II Dipartimento di Medicina Clinica e Chirurgia, Naples, Italy
- 2Universita degli Studi di Siena Dipartimento di Scienze Mediche Chirurgiche e Neuroscienze Sezione di Medicina e Chirurgia, Siena, Italy
- 3Hopital Universitaire Mere-enfant Robert-Debre, Paris, France
- 4comegen, Naples, Italy
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Background. 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 selected women and men scheduled to undergo BMD-DXA according to EALs. Results. BMD was evaluated in 18087 subjects [Male (M): Female (F) 889: 17198; mean age 71.3 ± 9.3 years; body mass index (BMI): 26.9 ± 4.5 Kg/m2] for primary OP and in 6503 subjects (M: F 649: 5854; mean age 70.5 ± 9.4 years; BMI; 25.4 ± 4.8 Kg/m2) for secondary OP, both suspected on the basis of EALs. Primary OP was confirmed by DXA in 13759 (80.0%; mean age71.9 ± 9.2 years; BMI: 26.5 ± 4.8 Kg/m2) women and in 551 men (62.0%; mean age 69.3 ± 9.4 years; BMI: 26.5 ± 4.8 Kg/m2). Secondary OP was confirmed by DXA in 4683 women (80.0%; mean age 70.7 ± 8.9 years; BMI; 25.3 ± 5.0 Kg/m2) and in 514 men (79.2%; mean age 69.7 ± 9.4 years; BMI: 26.3 ± 5.3 Kg/m2). The positive predictive values of EALs for OP was higher among women for primary Op than men, and similar in both genders without any significant difference in secondary OP. Conclusion. Italian EAL are a useful diagnostic tool for primary of OP in both sexes, with significant gender dimorphism evident in secondary OP.
Keywords: Osteoporosis, DXA, bone mineral density, Essential assistance levels, male osteoporosis
Received: 20 Aug 2025; Accepted: 28 Nov 2025.
Copyright: © 2025 Abate, Vergatti, Cavati, Magelli, Varriale, Merlotti, De Filippo, Piccinocchi, D'Elia, Gennari and Rendina. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Veronica Abate
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