Screening

Studies consistently show substantially lower rates of osteoporosis screening in men vs women. One study of 8262 patients found that DXA screenings occurred in only 18.4% of men who were eligible for inclusion in the study based on age, compared with 60% of women.18 Results of other studies revealed that 27% of women with a hip fracture had been screened for osteoporosis within the previous 5 years vs 11% of men.17

This may be partially explained by the “older age of onset, the high amount of comorbidities that such patients may have, the physician’s and patient’s lack of awareness, and the insurance coverage,” as stated in the review.2 Screening recommendations from professional organizations are inconsistent or unclear, which may be another reason for the discrepancy, although most guidelines recommend that all male patients 70 years be screened.

“One of the barriers to discussing male osteoporosis is the fact that it is still thought of as a ‘female’ disease by both patients and some healthcare providers,” Dr Peoples added. “It is important to consider a diagnosis of osteoporosis in both women and men as they age — in particular, careful attention [must be paid] to screening men with risk factors for osteoporosis.”

The central DXA scan, which measures bone density at the hip, distal radius, and spine, is the most validated tool for osteoporosis screening and for predicting the risk of future fractures in both men and women. Another widely used tool for predicting fracture risk is the Fracture Risk Assessment Tool (FRAX), although it may underestimate the risk in men vs women.19


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Next Steps

“Regardless of sex, patients with osteoporosis need to have improved treatment rates, and a great deal of additional study is needed for male osteoporosis in regard to the disease course itself, clear screening guidelines, and treatment effectiveness,” said Dr Peoples. For example, while bisphosphonates are recommended in men with osteoporosis, the specific male response to these and other interventions is unclear because most treatment trials have consisted primarily of women. Further research is also warranted regarding prevention of fractures in men and improved treatment following fracture.

“Given that rheumatologists are specialists playing key roles in the treatment of the aging population, it is important for them to realize the disparities in prevention, screening, and treatment of male osteoporosis,” Dr Peoples noted. “Patient education regarding male osteoporosis is critical in allowing for a broadening discussion of male osteoporosis screening, treatment, and complications.”

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References

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