Older Men Need More Aggressive Osteoporosis Screening

Example of distal radial epiphysis fracture

Older men would benefit from more aggressive osteoporosis screening and treatment, according to a new study.

“The prevalence of fragility fractures among men is expected to increase 3-fold by the year 2050,” said senior author Tamara Rozental, MD, Associate Professor of Orthopedic Surgery at Harvard Medical School. “Adequately evaluating and treating men for osteoporosis is of paramount importance.”

Fractures of the distal aspect of the radius are common, yet little is known about this type of fracture among older men. Distal radial fracture is the most common upper extremity fracture and is associated with increased risk of future fractures. Recent data show that patients experience peak rates of distal radial fracture between ages 50 and 64.

The researchers set out to compare fracture characteristics, treatment, and osteoporosis evaluation among nearly 450 patients who had sustained a distal radial fracture. “We hypothesized that the men would have similar patterns of injury and lower rates of evaluation for osteoporosis. It turns out that significantly fewer men received evaluation for osteoporosis following a distal radial fracture, with rates of evaluation unacceptably low according to published guidelines,” they state.

The researchers retrospectively reviewed the medical records of the patients who were treated for a distal radial fracture at their institution between 2007 and 2012. They assessed whether the patients had received a dual x-ray absorptiometry (DXA) scan and osteoporosis treatment within 6 months following the injury. Multivariate analysis identified independent predictors of bone mineral density (BMD) testing and osteoporosis treatment.

The results show that the men did not have severe fractures, but fewer than 1 in 5 men had a DXA scan after injury. Among the patients who underwent a DXA scan, only 9% of men received a diagnosis of osteoporosis. Only one-third of the osteoporotic men received pharmacologic treatment.

“Male sex was an independent predictor of failure to undergo BMD testing as well as receive subsequent treatment with calcium and vitamin D or bisphosphonates,” Dr Rozental said.

The study determined that men over age 50 years sustained a less severe distal radial fracture at a younger age. “Our observations support the findings of recent studies following hip fractures, which have shown that men are not being appropriately evaluated for osteoporosis or receiving adequate treatment for low BMD when testing does occur,” Dr Rozenthal states. Male sex also has been found to be an independent predictor of failure to perform BMD testing or initiate treatment in high-risk patients with fragility fractures, despite intensive primary care physician and patient education.

“Treating men for bone fractures, but not the underlying cause, places them at a greater risk for future bone breaks and related complications,” said Dr Rozental. “The results of this study lead us to suggest that men over the age of 50 with fractures of the distal radius should undergo further clinical assessment and bone density testing to better identify those at high risk for future fracture as well as those who would benefit from further treatment.”

The researchers reported their results in the November 5, 2014, issue of the Journal of Bone & Joint Surgery.

References:

Harper CM, Fitzpatrick SK, Zurakowski D, et al.  Distal radial fractures in older men: a missed opportunity?  J Bone Joint Surg Am. 2014;96:1820-1827. http://dx.doi.org/10.2106/JBJS.M.01497