Older Women Far More Likely Than Older Men to Be Tested, Treated for Osteoporosis

Older men are less likely than older women to have their bone mineral density measured and be prescribed treatment for osteoporosis, according to research published in Journal of Investigative Medicine.

The researchers studied 13,704 men and women 70 years and older who had a 10-year hip fracture risk assessed by limited FRAX score and who received care at a Department of Veterans Affairs medical center between January 2000 and August 2010.

The study population was split into 2 groups: 11,604 men and 463 women with age alone as a risk factor for a hip fracture and 1637 men at higher risk of osteoporosis due to a previous fracture, steroid treatment, or hormone (androgen) deprivation therapy.

The threshold criterion for treatment was a 10-year hip fracture risk of 3% or higher, which 48% of men between the ages of 75 and 79 years met. For men 80 years and older, 88% met the threshold. Among the men considered at higher risk, between 69% and 95% had a 10-year hip fracture risk.

Only 12% of the men in the study underwent dual-energy X-ray absorptiometry compared with 63% of women, and only 18% of men had serum 25-hydroxy vitamin D measurements performed compared with 39% of women. Compared with women, fewer men received prescriptions for calcium/vitamin D (63% vs 20%) and bisphosphonate (44% vs 5%).

Among men who were 80 years or older, only 10% to 13% had a bone density scan and fewer than 1 in 10 were treated with bisphosphonates.

Unfortunately, the researchers were not able to pinpoint why older men were not getting screened and treated for osteoporosis. Some of the reasons they suggested included that clinicians might not be aware of osteoporosis screening guidelines for men or that physicians were prioritizing other illnesses during the time they had with patients.

“Considering the known morbidity and mortality, our findings underscore the need for improved evaluation and management of osteoporosis in older men at high risk for fracture,” the authors concluded.

Reference

Narla RR, Hirano LA, Lo SHY, Anawalt BD, Phelan EA, Matsumoto AM. Suboptimal osteoporosis evaluation and treatment in older men with and without additional high-risk factors for fractures. J Investig Med. 2019;67(4):743-749. doi: 10.1136/jim-2018-000907.