ACR 2020

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.