Wednesday, May 7, 2008

Screening Men for Osteoporosis-New Clinician Guidelines

The American College of Physicians has issued guidelines for performing bone mass density tests in older men, recognizing that “osteoporosis if not just a woman’s disease”. Lead author, Amir Qaseem, MD, PhD, MHA concludes: "Older men, especially those over the age of 65, need to be assessed regularly for their risk of osteoporosis." The recommendations come about because of the increasing incidence of osteoporosis among men. The guidelines are published in the May 6 issue of the Annals of Internal Medicine.

Men, who experience fractures as the result of loss of bone mass, are twice as likely to die from complications when compared to women with fractures. The evidence comes from a review of articles published on MEDLINE from 1990 to 2007. Articles from experts were reviewed as well as other referenced material that evaluated risk fractures in men.

The osteoporosis foundation is urging clinicians to screen high-risk men from age 50 to 70 and all men over 70 by using a BMD or bone mass density test, also known as a DEXA scan. For men who have already suffered a fracture, BMD testing is recommended to determine the severity of the fracture.

Risk factors for men include androgen deprivation, spinal cord injury and advanced age. Sedentary lifestyle, poor dietary intake of calcium, low body mass index, weight loss of more than 10% and the use of prescription steroids are all indications that bone density should be viewed.

According to estimates, the incidence of osteoporosis in men is expected to increase by 50% during the next fifteen years, and the rate of hip fractures is expected to double. The current statistics for osteoporosis in men are 7%, 5% and 3% in whites, African –Americans and Hispanics respectively.

The risk of complications, the need for surgery and associated morbidity make routine screening a valuable tool for decreasing the burden of unnecessary injuries and hospitalization in men who are candidates for drug therapy to treat osteoporosis.

You doctor may now be asking questions about your calcium intake, tracking changes in your weight and insisting that more men get busy exercising to decrease the risk of osteoporosis. According to Dr. Qaseem, “Osteoporosis . . . is significantly under diagnosed and undertreated in men”. ◦