Because the medical literature and direct-to-consumer advertising have focused mainly on the burden of osteoporosis in postmenopausal women, recent screening guidelines for this disease in men may catch some by surprise.
When is screening for osteoporosis warranted in older men?
Because the medical literature and direct-to-consumer advertising have focused mainly on the burden of osteoporosis in postmenopausal women, recent screening guidelines for this disease in men may catch some by surprise. Did you know that the 1-year mortality for men after hip fracture is twice that of women?1 Or that the prevalence of osteoporosis in men is as high as 7% among those who are white, 5% among African Americans, and 3% among those of Hispanic heritage?2 A 50% increase in the incidence of osteoporosis in men is predicted during the next 15 years as well as a doubling of the hip fracture rate in men by 2040.2
NEW SCREENING GUIDELINES
The American College of Physicians (ACP) recently published a systematic review of the evidence for osteoporosis risk factors and appropriate screening practices in men; 167 studies were included in the meta-analysis.1,2 The following risk factors in men were identified:
•Age older than 70 years.
•Body mass index less than 20 to 25 kg/m2.
•Weight loss of greater than 10%.
•Previous osteoporotic fractures that were unrelated to significant trauma.
•Use of certain pharmacological agents, such as corticosteroids for chronic inflammatory disease.
•Androgen deprivation therapy (eg, for advanced stage prostate cancer).
•Spinal cord injury.
The guidelines recommend that older men should be evaluated for these risk factors and dual-energy x-ray absorptiometry (DEXA) scans should be considered for those at increased risk. Screening tests other than DEXA scans were also studied, but it was concluded that none were sufficiently sensitive or specific to warrant consideration at this time.2 The treatment of men who meet the diagnostic criteria for osteoporosis should be identical to that of women who have the disease.
FUTURE IMPACT ON THE HEALTH CARE SYSTEM
The impact of a large population of baby boomers reaching “Medicare age”-called by some the “silver tsunami”-has led to changes in disease epidemiology and manifestations that were not considered likely a decade ago, such as men with serious complications from osteoporosis. Just as the depletion of estrogen in postmenopausal women leads to serious bone pathology, so does decreased physical activity, weight loss, hormonal changes, and the effects of certain medications in men who are in their seventh to eighth decades of life. Osteoporosis, which is now becoming a significant pathology in men, is another looming health care issue that will strain Medicare’s budget over the next 20 years.
Liu H, Paige NM, Goldzweig CL, et al. Screening for osteoporosis in men: a systematic review for an American College of Physiciansguideline.
Ann Intern Med.
. Qaseem A, Snow V, Shekelle P, et al; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening forosteoporosis in men: a clinical practice guideline from the American College of Physicians.
Ann Intern Med.