Screen men for osteoporosis
Men older than 50 years of age should be regularly assessed for osteoporosis risk factors, according to new guidelines from the American College of Physicians (ACP).
“Osteoporosis is not just a women's disease. It is underdiagnosed and undertreated in men,” says Amir Qaseem, MD, PhD, a senior medical associate with the ACP. The resulting fractures can lead to substantial morbidity, mortality, and expenses, the guidelines note. For example, men are twice as likely as women to die within a year of a hip fracture.
The guidelines call for risk assessments at unspecified intervals and bone-density tests for men at high risk who are candidates for bone-preserving drug therapy (Ann Intern Med. 2008;148:680-684).
One of the primary risk factors is age over 70 years, but the guidelines target men older than 50. “The appropriate age to start risk assessment is uncertain,” the authors acknowledge. “However, by age 65 years, at least 6% of men have osteoporosis, so assessment before this age is reasonable.”
Other risk factors include low body weight (BMI <20-25); significant, unintentional weight loss of >10%; physical inactivity; the use of certain drugs; a low-calcium diet, and a previous fragility fracture that can't be blamed on substantial trauma, systemic corticosteroid therapy, androgen deprivation therapy, or spinal cord injury.
The ACP guidelines for men are unique, the authors note. Currently, the National Osteoporosis Foundation recommends bone mineral density tests only for men aged 70 or older, and the U.S. Preventive Services Task Force has no recommendation for men at all.