Screen All Men Age 85 and Older for Osteoporosis

Fran Lowry

May 04, 2018

ORLANDO — All men 85 years and older should be screened for osteoporosis, and men as young as 65 years should be tested if they have certain risk factors for fracture, according to a new study.

Cathleen Colon-Emeric

"Osteoporosis is often considered a disease of women, but it actually has a major impact on men," said Cathleen Colon-Emeric, MD, from the Duke University School of Medicine in Durham, North Carolina.

"Men are the forgotten population for this particular condition," she said here at the American Geriatrics Society 2018 Annual Scientific Meeting.

"For example, a man has a higher risk of having a major osteoporotic fracture than getting prostate cancer, but nobody really thinks of screening men for osteoporosis. We're trying to address that," she told Medscape Medical News.

A man has a higher risk of having a major osteoporotic fracture than getting prostate cancer, but nobody really thinks of screening men for osteoporosis.

Clinical practice guidelines are clear on when women should be screened but not when men should be tested. "There are multiple conflicting recommendations around the world on whether to screen men for osteoporosis at all and, if so, when, which men, and at what age," she explained.

Colon-Emeric and her colleagues wanted to determine whether there is a benefit to screening men for primary osteoporosis.

The team assessed data on 2,539,812 men 65 to 99 years of age with no history of fracture from the Centers of Medicare and Medicaid Services and Veterans Administration.

They used propensity scores to match men who had undergone osteoporosis screening with dual energy x-ray absorptiometry during routine care with men who had similar risk factors for fracture and a similar probability of being screened but who had not undergone any screening.

Of the 183,943 men who had undergone screening, 33,224 (18%) were older than 80 years.

Fracture rates were 15% lower in the screened population than in the overall population (hazard ratio, 0.85; 95% confidence interval, 0.81 - 0.90).

Slightly more men older than 80 years than younger men met the threshold to receive at least one prescription for an osteoporosis medication (16.3% vs 13.4%).

For men with no known risk factors for fracture, the age at which screening becomes more effective than not screening is approximately 85 years.

"Our findings not only support universal osteoporosis screenings for all men over age 85, but also suggest that men as young as 65 may benefit from diagnostic evaluation when certain risk factors are present," Colon-Emeric reported. "In the younger men with risk factors, there is a 10% reduction in hazard with screening."

Certain medications, such as steroids and those for prostate cancer, are risk factors, as are certain chronic conditions, such as chronic lung disease, chronic liver disease, rheumatoid arthritis, diabetes, thyroid disease, and Parkinson's disease.

"Any man age 85 and older, as long as we think he is going to have a 2-year life expectancy and live long enough to benefit from osteoporosis treatment, should be considered for screening," she added.

There is actually "a real crisis in the treatment of osteoporosis," said Colon-Emeric. "Treatment and adherence rates started going down around the time we started to see some news stories coming out in the New York Times and other places reporting serious but very rare side effects of those medications. It scared a lot of people."

Educating patients about the risks and benefits of osteoporosis medication requires a careful discussion, she explained.

"In general, if you're at high risk for fracture, the benefits of these medications far outweigh the very small risk. The National Bone Health Alliance, the National Osteoporosis Foundation, and the American Society of Bone and Mineral Research are doing media and educational campaigns to help patients understand that, certainly, there are risks for any medication, but there are also substantial benefits," she pointed out.

A Landmark Study

Alayne Markland

This "landmark study" adds "significant evidence" for the benefit of osteoporosis screening for men 85 years and older, said Alayne Markland, DO, from the University of Alabama at Birmingham, who is associate director of the Birmingham/Atlanta Geriatrics Research Education and Clinical Center.

The findings "affect clinical care and guidelines for community-dwelling men," she told Medscape Medical News.

Although 85 years might seem old, "the data show that 85 years is the inflection point at which screening made a difference. We are seeing our population live longer and, even at 85, at least that's a starting point for screening with some evidence behind it," she said.

"A hip fracture can take someone 85 years or older who is fully functional and who has a 5-year life expectancy to being nonfunctional with a life expectancy of perhaps 1 year or less, so screening can have a profound impact if osteoporosis is found and treated appropriately," Markland said.

This study was supported by the US Department of Defense. Colon-Emeric reports being a consultant for Novartis and Amgen and receiving research support from Amgen. Markland has disclosed no relevant financial relationships.

American Geriatrics Society (AGS) 2018 Annual Scientific Meeting: Abstract P2. Presented May 3, 2018.

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