Osteoporosis Screening in Primary Care: Early Implementation Gaps Following the 2023 Saudi Guideline Update

Objective: To assess adherence to the 2023 Saudi Osteoporosis Society (SOS) universal screening guideline among adults aged ≥60 years in an academic primary care center and identify factors associated with DEXA ordering. Methods: A retrospective EMR-based study included 2186 patients aged ≥60 years attending a university-affiliated primary care center (May 2023-December 2025). The primary outcome was adherence to SOS 2023 recommendations. Multivariable logistic regression identified predictors of BMD ordering. Results: BMD screening was ordered for 19.7% of eligible patients; only 4.1% completed testing. Screening was independently associated with female sex (aOR 5.26), prior osteoporosis (aOR 139.40), prior fracture (aOR 10.35), and female physician sex (aOR 1.50) (all p<0.05). Conclusion: Adherence to universal screening remains low, with a substantial gap between DXA ordering and completion, highlighting important implementation barriers in primary care practice.