Providers should assess older men for risk factors for osteoporosis and measure bone density by dual-energy x-ray absorptiometry if any risk factors are present, a new guideline from the American College of Physicians recommends.
How old is “older” is left open to interpretation and is one point of difference between the new guideline and separate new guidelines issued by the National Osteoporosis Foundation (NOF) in February 2008. The recommendation by the ACP is the first from the organization to specifically address osteoporosis in men (Ann. Intern. Med. 2008;148:680–4).
The new NOF guidelines for the first time include screening and treatment in men as well as women, and recommend doing bone density testing in men aged 50–69 years who have risk factors for osteoporosis and in all men aged 70 years or older.
The new ACP guideline focuses specifically on osteoporosis screening in men and notes that the appropriate age at which to start risk assessment is uncertain. The medical evidence in the literature shows that by age 65 years, at least 6% of men have osteoporosis proved by dual-energy x-ray absorptiometry (DXA), so “assessment of risk factors before this age is reasonable” for most men, Dr. Amir Qaseem said in an interview.
The ACP plans to issue a separate new guideline for treating osteoporosis in men in the near future, added Dr. Qaseem, lead author of the guideline and a senior medical associate for the ACP.
The main risk factors for osteoporosis in men that should prompt providers to consider ordering a DXA scan are age older than 70 years, low body weight (a body mass index of 25 kg/m
If a man with risk factors declines a bone density test, the provider should periodically revisit the topic with him and explain that the DXA scan is a painless, noninvasive test.
The new ACP guideline is based on a review of evidence published in 1990–2007 conducted by the federal Agency for Healthcare Research and Quality's evidence-based practice center in Southern California. Another article in the same issue describes the review of evidence (Ann. Intern. Med. 2008;148:685–701).
The prevalence of osteoporosis is estimated to be 7% in white men, 5% in black men, and 3% in Hispanic men. Because it's “viewed as a disease of women,” it is underdiagnosed and undertreated in men, causing substantial morbidity and mortality, said Dr. Qaseem. In the next 15 years as the population ages, the rate of osteoporosis in men is expected to increase by half, with a doubling or tripling of hip fracture rates by 2040.
The prevalence of osteoporosis in Asian American men and other ethnic groups is unknown because of a lack of data. More research is needed on multiple aspects of screening for osteoporosis in men, the guideline states.
The medical evidence in the literature shows that by age 65 years, at least 6% of men have osteoporosis. DR. QASEEM