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

Malak A Alshammari Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Malak A Alshammari, Email moalshammari@iau.edu.saObjective: 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.Keywords: osteoporosis, bone mineral density, primary health care, guideline adherence, implementation gap, Saudi Arabia