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Few Older Men Receive Optimal Osteoporosis Evaluation, Treatment

February 25, 2019

By Reuters Staff

NEW YORK (Reuters Health) - Older men are far less likely than older women to undergo screening and treatment for osteoporosis, according to results from one Veterans Affairs Medical Center.

The Endocrine Society, the National Osteoporosis Foundation and the International Osteoporosis Foundation recommend bone densitometry in women aged 65 and older, men aged 70 and older and men and women >50 years old who have secondary causes of osteoporosis.

The Veterans Health Administration recommends bone densitometry for men at a very high risk for fractures, including hip-fracture patients, patients on chronic oral glucocorticoids and patients on androgen-deprivation therapy (ADT). How well any of these recommendations has been followed remains unclear.

Dr. Radhika Rao Narla and colleagues from the University of Washington School of Medicine and Veterans Affairs Puget Sound Health Care System, in Seattle, investigated the prevalence of case finding, evaluation and therapeutic management of osteoporosis among older men and women (70 or older) and among older men at very high risk for fracture using an electronic database from the Veterans Integrated Service Network 20 data warehouse.

The proportion of FRAX hip fracture risk scores of 3% or higher (the usual threshold for pharmacotherapy) was consistently higher among women than among men of the same age. Still, 48% of men aged 75-79 and nearly 90% of men aged 80 years or higher exceeded this threshold.

In each of these subgroups, however, only 13% and 10%, respectively, had undergone bone densitometry, and only 6% and 7%, respectively, had received bisphosphonate treatment, the researchers report in the Journal of Investigative Medicine, online February 5.

Overall, 63% of women 70 years and older with age alone as a risk for fractures had bone densitometry checked and 63% received calcium/vitamin D supplements. Among men in the same age group, only 12% had bone densitometry checked and 20% received calcium/vitamin D supplements.

Among very-high-risk older men, 95% of those with hip fracture, 69% of those with chronic corticosteroid use and 74% of those on ADT exceeded the 3% FRAX score treatment threshold. Still, less than 40% in each subgroup had a bone densitometry obtained, less than 30% in each subgroup had serum 25-hydroxy vitamin D concentrations measured and less than 25% in each subgroup had received bisphosphonate treatment.

"Our findings suggest that guidelines and education of providers are inadequate in effectively identifying older men who might benefit from evaluation for osteoporosis and fracture prevention treatment," the researchers conclude. "Although our study was performed in a veteran population receiving care in the VA system, we believe that there is a need for developing strategies to improve the evaluation and management of osteoporosis in all older men, particularly among elderly men with a very high risk of fracture, such as those men with previous osteoporotic fracture or who are on long-term corticosteroid or ADT."

Dr. Narla did not respond to a request for comments.


J Investig Med 2019.

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