Osteoporosis Goes Underdiagnosed and Undertreated in Men

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Many men are breaking bones that might be protected with more routine screening and treatment for osteoporosis, researchers say.

“It is often misconstrued as a disease that really, mainly, if not only, effects Caucasian women, which is not the case,” said Jeffrey Curtis, MD, MS, MPH, professor of medicine in the Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham. He presented his findings at the annual meeting of the American College of Rheumatology on Saturday.

Jeffrey Curtis, M.D., MPH

Numerous world medical organizations, including the United States Preventive Services Task Force, World Health Organization, National Osteoporosis Foundation (NOF), the American Academy of Family Physicians, and American Association of Clinical Endocrinologists recommend screening for women over the age of 65.

The NOF recommends screening for men who either have high risk factors or are over the age of 70, but Dr. Curtis and his colleagues could find no other osteoporosis screening recommendations for men.

The researchers wanted to see if this gap in screening was leading to a significant number of cases going undiagnosed, so they analyzed records of 9,876 male Medicare patients who had suffered a closed-fragility, or osteoporosis-related fracture between January 2010 and September 2014.

They found that only about 6% of the men had received any screening or treatment for osteoporosis in the two years prior to their fracture, even though 62.8% had a history of musculoskeletal pain. Overall, 2.8% of the patients were diagnosed and not treated, 2.3% were treated but not diagnosed, and only 2.1% were both diagnosed and treated in the year before the fracture.

In the year after the fracture, only about 10% of patients under went bone mineral density testing, and only 9% were treated for osteoporosis. About 7% of the men had a second fracture in the year following their first injury.

And the problem seems to be getting worse. The researchers found a declining trend in bone mineral density scans from 2012 to 2014.

Dr. Curtis hopes that his team’s findings will lead to more screening and better health outcomes among men with osteoporosis. “It’s quite clear based on the results that men are largely being ignored with respect to osteoporosis and fractures,” said Dr. Curtis. “Nobody’s mentioning, ‘Hey there’s effective medication that might help you avoid a future fracture.’”

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REFERENCE

ABSTRACT: 0533. “Characterization of Older Male Patients with a Fragility Fracture.” The annual meeting of the American College of Rheumatology. 9:00 AM Saturday, Nov. 7, 2020.