Highlights from

ACR 2020

ACR Convergence 2020

Virtual 5 - 9 November 2020

Osteoporosis in men – often overlooked, rarely treated

A Medicare retrospective cohort study discovered that when it comes to screening and treatment of osteoporosis, not enough attention is given to male patients, even in the most at-risk men with comorbid conditions associated with falls. Better management of male osteoporosis, including earlier identification of at-risk individuals, is warranted.

“Current recommendations for testing of male osteoporosis patients are rather inconsistent, leading to a lot of ambiguity and a further increase in disease burden,” stated Prof. Jeffrey Curtis (University of Alabama at Birmingham, USA), the trial co-author who presented the study data [1]. The current retrospective study used a cohort of males with Medicare enrolment who experienced a fracture, to characterise this population and in particular to whether males who had a fracture had been effectively screened and treated.

The trial included male Medicare fee-for-service beneficiaries of ≥65 years of age who had sustained a closed fragility fracture between 01 January 2010 and 30 September 2014. All patients had to be non-stop registered with Medicare ≥1 year before to ≥1 month after index date.

Of the 9,876 included beneficiaries, 90.3% were Caucasian and 61% ≥75 years old, with a mean age of 77.9 years. Fractures were for instance located in the spine (30.8%), hip (26.7%), and forearm (9.0%). Before their fragility fracture, 62.8% of the men were known to suffer from musculoskeletal pain, with 48.5% receiving opioids. Also, many other comorbidities or medications that increase the fall risk, such as medication for mobility impairment (22.4%), beta blockers (44.0%), and alpha blockers (35.8%).

However, bone mineral density tests had only been performed in less than 6.0% within the last 2 years. The vast majority of these patients (92.8%) were neither diagnosed with nor treated for osteoporosis before their fracture. Of note, only 2.1% received treatment for osteoporosis, while 2.8% were diagnosed but did not receive therapy for osteoporosis and 2.3% were treated without an established diagnosis. Especially in the older male patients ≥75 of age, the rates for undergoing bone density scans decreased between 2012 (6.0%) and 2014 (4.3%).

Hence, Prof. Curtis stressed that there is a fairly high amount of under-diagnosis and under-treatment of osteoporosis, even in the most at-risk men with comorbid conditions associated with falls. “Better management of male osteoporosis, including earlier identification of at-risk individuals, is warranted. That way, they can be screened and identified as having high-risk conditions and low bone density and put on effective therapy to mitigate fracture risk and the subsequent morbidities and mortality that it ensues,” Prof. Curtis concluded.

  1. Setareh AW, et al. Characterization of older male patients with a fragility fracture. P0533, ACR Convergence 2020 Virtual Annual Meeting, 5-9 November 2020.

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