In a new study, researchers found that many older men who experience a fracture are still under-diagnosed with and under-treated for osteoporosis.
The research was conducted by a team at the University of Alabama at Birmingham.
Osteoporosis is a common condition that results from a loss of bone mass, measured as bone density, and from a change in bone structure.
Bone is living tissue that is in a constant state of regeneration. By their mid-30s, most people begin to slowly lose more bone than can be replaced.
As a result, bones become thinner and weaker in structure. This accelerates in women at the time of menopause. In men, bone loss usually becomes more of an issue around age 70.
Osteoporosis can cause a big burden upon patients, including physical symptoms, increased cost of healthcare and mortality.
Approximately one-quarter of patients with fractures are male, and emerging evidence suggests that men with osteoporotic fractures have worse outcomes than women.
This new study looked at the baseline characteristics of male Medicare patients who have had an osteoporosis-related fracture.
Addressing the absence or gap in undergoing bone density screening was the major reason for the study.
The study included 9,876 Medicare beneficiaries. Sixty-one percent were 75 or older and 90% were white.
Fewer than 6% had a bone mineral density test with DXA, the standard test, in the two years before their fracture.
Researchers also found that two-thirds (62.8%) of the patients had a history of musculoskeletal pain and nearly half (48.5%) had a history of opioid use one year prior to their fracture.
The most common sites of fractures were the spine, hip, and ankle.
Of all patients with a qualifying fracture, about 92% did not have any claim for a DXA test or prescription claim for osteoporosis treatment in the two years prior to their index fracture.
At baseline, 2.8% had been tested and not treated, 2.3% were treated but not tested, and only 2.1% were both tested and treated.
The decline in the DXA scans in 2012 to 2014 was particularly high among men 75 years and older who are more likely to be at risk of fracture.
The team says while many comorbidities (i.e., heart disease) are commonly recognized and treated in men, sometimes even more than women, osteoporosis is not one of them.
Even post-fracture for major fractures like a hip, rates of treatment are disappointingly low, leaving men at risk for yet another fracture.
There is also a lack of consistent guidelines for osteoporosis screening recommendations for men.
Among women, doctors recommend screening women over 65 years of age. However, among men, these groups do not make any recommendation at all, except for the NOF which recommends that all men over 70, and those between the ages of 50 to 69 who have risk factors, must be screened.
Based on the study’s conclusions, earlier identification of high-risk male patients who might benefit from targeted osteoporosis screening and therapies would be of great value, the researchers say.
One author of the study is Jeffrey Curtis, MD, MS, MPH, Professor of Medicine.
The study was presented at ACR Convergence, the American College Rheumatology’s annual meeting.
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