Older males are underdiagnosed and undertreated for osteoporosis
A new study shows that many older men who develop a fracture are still underdiagnosed and treated for osteoporosis. Details of the study were presented at ACR Convergence, the annual meeting of the American College Rheumatology (ABSTRACT # 0533).
Osteoporosis is a common condition that results from a loss of bone mass, measured as bone density, and changes in bone structure. Bone is living tissue that is constantly regenerating. By their mid-30s, most people slowly lose more bones than can be replaced. As a result, the bones become thinner and weaker in structure. This accelerates in women at the time of menopause. In men, bone loss usually becomes a bigger problem around the age of 70.
Osteoporosis can place significant stress on patients, including physical symptoms, increased health care costs, and mortality. About a quarter of patients with fractures are men, and recent evidence suggests that men with osteoporotic fractures have worse outcomes than women. This new study examined the basic characteristics of male Medicare patients who had an osteoporosis-related fracture. The primary reason for the study was to address the absence or void in the performance of a bone density screen.
Men are usually not part of the routinely recommended screening with DXA and are therefore both underdiagnosed and under-treated. While many comorbidities (i.e., cardiovascular diseases) are often detected and treated in men, sometimes more so than in women, osteoporosis is not one of them. Even after a fracture for larger fractures like a hip, treatment rates are disappointingly low, putting men at risk for another fracture. There is also a lack of consistent guidelines for osteoporosis screening recommendations for men. Among women, the World Health Organization, the American Association of Clinical Endocrinologists, the United States Preventive Services Task Force, the National Osteoporosis Foundation (NOF), and the American Academy of Family Physicians recommend screening women over the age of 65. In men, however, these groups make no recommendation at all, with the exception of the NOF, which recommends that all men over 70 and those between 50 and 69 with risk factors should be screened. “
Jeffrey Curtis, MD, MS, MPH, study co-author, Professor of Medicine, Department of Clinical Immunology and Rheumatology, University of Alabama, Birmingham
The researchers looked at Medicare Fee-for-Service (FFS) beneficiaries who had a fracture with closed fragility or osteoporosis between January 2010 and September 2014. Inclusion criteria for the study included age 65 or older at the time of the index date and continued enrollment with Medicare FFS with medical and pharmacy benefits for at least one year prior to the index date until at least one month after. Medicare beneficiaries were excluded if they died within 30 days of the index date. They also excluded patients with Paget’s disease or any malignant disease, with the exception of skin cancer without melanoma, at baseline. Patients were divided into four groups based on their diagnoses and / or baseline treatment for osteoporosis. Osteoporosis diagnoses can be listed in any position in a medical claim.
The study included 9,876 Medicare beneficiaries. 61% were 75 years or older and 90% were white. Less than 6% had a bone mineral density test using DXA, the standard test, in the two years prior to their fracture. The researchers also found that two-thirds (62.8%) of patients had a history of musculoskeletal pain, and nearly half (48.5%) had a history of opioid use a year before their fracture. The most common fracture sites were the spine, hip, and ankle. Of all patients with a qualified fracture, approximately 92% were not eligible for a DXA test or prescription-only treatment for osteoporosis in the two years prior to their index fracture. At baseline, 2.8% were tested and untreated, 2.3% were treated but not tested, and only 2.1% were both tested and treated. The decline in DXA scans from 2012 to 2014 was particularly high in men aged 75 and over, who are at higher risk of breakage.
Based on the study’s conclusions, earlier identification of high-risk male patients who could benefit from targeted osteoporosis screening and therapies would be of great value, the researchers say.
“There is a need for a consistent recommendation for osteoporosis screening in men,” says Dr. Curtis. “Incorporating these recommendations into measures to improve the quality of care for osteoporosis management and post-fracture care is warranted to improve health outcomes in this population. There is a need for better characterization of the high-risk patient for the next steps in this area, including Existing comorbidities that may have a common etiology or risk factors that may allow earlier identification and treatment. “
American College of Rheumatology