Men's Osteoporosis Support Group

Osteoporosis screening for men

Can Fam Physician. 2008 Aug;54(8):1140-1141, 1141.e1-5. Osteoporosis screening for men: are family physicians following the guidelines? Cheng N, Green ME. PMID: 18697977. There is a free copy of this study online, just click on Full Text (PDF) to download and read. This Canadian study examined the rates at which family practice physicians screened men older than 65 for osteoporosis as recommended by Canadian guidelines. The authors reviewed a total of 20 different family practices and found, that of a total of 565 patients, 108 (19.1% of the study population) had received bone mineral density (BMD) screening. Screening rates for the various practices ranged from 0% to 38%. Of those screened, 15 (14.3%) were found to have osteoporosis, 43 (41.0%) to have osteopenia, and 47 (44.8%) to have normal BMD results. Screening rates improved with increasing patient age. The authors conclude: "On average, only about 20% of male patients older than 65 years had been screened for osteoporosis, so most of these men were not being screened by BMD testing as recommended in the guidelines."

Editor's comments: A total of 457 patients didn't get BMD screening, meaning about 20% of them, 91 men, didn't have their osteoporosis diagnosed or treated. In the United States there is no current recommendation for screening to start at 65 unless certain risk factors suggest that might be needed, to my knowledge. The Liu and others study below mentions screening before age 65 if risk factors warrant that, and it also mentions screening at age 70 for men who have low body weight or weight loss, and are not physically active. The National Osteoporosis Foundation recommends screening for men start at age 70. Ann Intern Med. 2008 May 6;148(9):685-701. Screening for osteoporosis in men: a systematic review for an American College of Physicians guideline. Liu H and others. PMID: 18458282 outlines risk factors for men that would indicate BMD screening is needed. There is also a summary for patients online. The Liu and others study's risk factors include: increased age, low body weight, weight loss, physical inactivity, prolonged corticosteroid use, previous osteoporotic fracture, and androgen deprivation therapy.

The important issue for men who have the key risk factors listed above is to take the initiative to have their BMD evaluated. It apparently will be quite some time, if ever, before practitioners take test adequate numbers of men for osteoporosis. To explain how important this is, note the following that is mentioned in the Cheng and Green study.

Men are twice as likely as women to die in hospital after hip fractures.
One-year mortality rates range from 31% to 40% in men vs. 17% to 20% for women after hip fracture.
One study showed an 8-fold increase in mortality after hip fractures in men and that mortality continued to increase after two years.
Another study of 363 patients admitted for low-energy hip fractures showed that 30% of surviving male patients required a walker or wheelchair after fracture.
In the above study, the number of male patients participating in recreational activity dropped by 50% after fractures.

So a man's goal should be to prevent fractures, not treat them after they occur. Men should also remember that a low-trauma fracture of any kind means you have osteoporosis until testing determines otherwise. So demand adequate BMD testing if you've had a low-trauma fracture and if you fit the guidelines for testing above.

Return to Home