Guidelines Issued for Screening Men for Osteoporosis

In May 2008, the American College of Physicians (ACP) issued new clinical practice guidelines for screening men for osteoporosis. The new guidelines recommend that clinicians assess risk factors for osteoporosis in older men. Currently, osteoporosis in men is substantially under-diagnosed, undertreated, underreported, and inadequately researched.

Amir Qaseem, MD, PhD, MHA, a senior medical associate in ACP's Clinical Programs and Quality of Care Department, says, "Older men, especially those over the age of 65, need to be assessed regularly for risk factors for osteoporosis. Osteoporosis is not just a women's disease."

Osteoporosis, which is characterized by low bone mass and structural deterioration of bone tissue, results in bone fragility and increased risk for hip, spine, and wrist fractures. Currently, the prevalence of osteoporosis is estimated to be 7% in white men, 5% in African American men, and 3% in Hispanic American men. However, rates of osteoporosis among men are rising and are projected to increase by nearly 50% during the next 15 years, with rates of hip fracture expected to double by 2040.

The National Osteoporosis Foundation has recommended that men 70 years of age and older undergo bone mineral density (BMD) testing. BMD testing is also recommended in men aged 50 to 70 years when the patient's risk factor profile indicates potential problems. The most important risk factors for osteoporosis in men are age (especially over 70), low body weight, physical inactivity, use of oral corticosteroids, previous fragility fracture, and/or androgen deprivation therapy.

The evidence to date shows that osteoporotic fractures are associated with significant morbidity and mortality in men, resulting in substantial disease burden, death, and healthcare costs. For men, the one-year mortality rate after hip fracture is twice that in women.

Based on this review, the ACP issued the following recommendations:

1. Clinicians should periodically evaluate older men for risk factors for osteoporosis, using an individualized assessment.

2. For men who are at increased risk for osteoporosis and who are candidates for drug therapy, a DXA scan should be performed.

3. The ACP also recommends additional research to evaluate osteoporosis screening tests in men.

Source: Qaseem, A., Snow, V., and colleagues. 2008. Screening for Osteoporosis in Men: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine, 148(9): 680-684.