Osteoporosis Significantly Underdiagnosed, Undertreated in Men

Diagnosis of Osteoporosis

Current guidelines recommend bone mineral density (BMD) evaluation after a fracture for both men and women. Yet, the latest data suggest that screening rates are unacceptably low for men. 

Investigators at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston recently conducted a review of medical records of 95 men and 344 women aged older than 50 years who were treated for a distal radial fracture. All the patients were treated at a single institution over a 5-year period. 

The study showed that following a wrist fracture, 53% of women received a dual x-ray absorptiometry (DXA) scan compared with only 18% of men.2  

“It is a problem that has been underestimated for a long time,” said lead author Tamara Rozental, MD, who is an Associate Professor of Orthopedic Surgery at Harvard Medical School in Boston.

She said all the patients in this study suffered their fractures between 2007 and 2012, and only 21% of men compared with 55% of women initiated treatment with calcium and vitamin D supplements within 6 months of injury. Interestingly, only 3% of men started taking a bisphosphonate, whereas 22% of women started taking a bisphosphonate.

Dr. Rozental said the prevalence of fragility fractures among men is expected to increase threefold by the year 2050. Adequately evaluating and treating men for osteoporosis is of paramount importance, she added.

“We need to discuss this issue more,” Dr. Rozental told Endocrinology Advisor. “We need to think of bone health and educate patients about it and we need to screen more for it and educate patients about what they can do, such as make dietary changes, exercise and other prevention steps.”

She said a distal radial fracture is commonly an early indication of bone loss. This type of facture typically occurs 10 to 15 years before a hip fracture. When treating fractures of the wrist, there is an opportunity to do a BMD evaluation and, if necessary, get patients into treatment. However, Dr. Rozental said there is still a historical bias among physicians and patients viewing osteoporosis as a woman’s disease.

The results of this study suggest that men aged older than 50 years with fractures of the distal radius should undergo further clinical assessment and BMD testing to better identify those at high risk for future fracture.

The clinical measurement of BMD using DXA remains the gold standard for diagnosis of osteoporosis in men and fracture risk assessment is now recognized as a preferred approach to guide treatment decisions in male osteoporosis.3