Men with osteoporosis as defined by World Health Organization (WHO) criteria are most likely to benefit from drug treatment, according to a study published in BMJ.
The researchers included 5,880 men aged at least 65 years from the Multicenter Osteoporotic Fractures in Men Study (MrOS) in their analysis. They categorized the participants as having osteoporosis according to WHO criteria alone; having osteoporosis according to NOF criteria alone; having a high fracture risk without osteoporosis; and having low fracture risk without osteoporosis.
Results indicated that 130 men had osteoporosis as defined by WHO criteria, and 422 additional men had osteoporosis as defined by the NOF definition. Total prevalence of osteoporosis was 9.4%, according to the study abstract.
The researchers found that 936 (15.9%) additional men without osteoporosis were identified as having a high fracture risk when the NOF-derived FRAX intervention thresholds were applied. The total prevalence of men eligible for drug treatment then climbed to 25.3%.
Data also showed that 10-year hip fracture probability was 20.6% for men with osteoporosis defined by WHO criteria alone vs. 6.8% for men with osteoporosis defined by NOF criteria alone. Additionally, 10-year fracture probabilities were 6.4% for men without osteoporosis but at high risk for fracture and 1.5% for men without osteoporosis and at low risk for fracture.
Further, men with osteoporosis as defined by WHO criteria had greater fracture probabilities than FRAX-predicted probabilities (hip fracture, 20.6% vs. 9.5%; major osteoporotic fracture, 30.0% vs. 17.4%).
The researchers concluded that extending the criteria for men who would benefit from drug treatment to prevent fracture beyond the WHO definition has “uncertain value.”
In this cohort of community dwelling older men living in the United States, we found that the choice of definition of osteoporosis and use of National Osteoporosis Foundation derived FRAX intervention thresholds had major effects on the proportion of men identified as candidates for drug treatment to prevent fracture.