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New findings on osteoporosis screening in older men differ from USPSTF
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New research suggests that men older than 65 years with known risk factors for fractures should be screened for osteoporosis, according to findings presented at the American Geriatrics Society annual meeting.
The U.S. Preventive Services Task Force stated in 2011, and again in 2017, that there is insufficient evidence to assess the balance of benefits and harms of screening men for osteoporosis.
“The way we are screening for osteoporosis in the VA is not working for most men; we are not always selecting the right people, not always starting medications in men who need them, and not ensuring that the men continue taking the medications long enough to decrease their fracture risk,” Cathleen Colón-Emeric, MD, MHS, professor of medicine at Duke University, and associate director of Geriatric Research Education and Clinical Center at the Durham VA Medical Center in North Carolina, told Healio Family Medicine.
“There is very little direct evidence to guide osteoporosis screening decisions in men, and as a result, practice guideline recommendations vary widely. This large observational study provides additional information to help patients and clinicians make screening decisions,” she continued.
Colón-Emeric and colleagues conducted a propensity score case-control study using data on 2,539,812 men aged 65 to 99 years from CMS and VA databases. They calculated propensity scores of the probability of osteoporosis screening within the next year, and determined differences in fracture between those who were screened and those who were.
Researchers found that 183,943 men were screened, of which 18% were aged older than 80 years. They also found screening was linked to a 15% lower hazard of fracture in men older than 80 years (HR = 0.85; 95% CI, 0.81-0.9). In addition, the proportion of participants who met the requirement for treatment and received at least one medication was 13.4% of all the men screened, and 16.3% of those older than 80 years.
According to researchers, these and other findings support screening men older than 65 years with risk factors for osteoporosis, and men older than 85 years should be screened for osteoporosis regardless of fracture risk factors.
“The very low treatment initiation and adherence rates observed in this large study of men is quite discouraging, but in line with trends in osteoporosis treatment nationally,” Colón-Emeric said in the interview.
“Unfortunately, we are facing a crisis in osteoporosis screening and treatment that seemed to begin following media coverage of the serious but very rare side effects of osteoporosis medications. Many patients underestimate their risk of fracture due to osteoporosis, and overestimate their chance of having side effects from the medications,” she noted, adding that her study can guide patients and clinicians in making screening decisions. – by Janel Miller
Reference: Colón-Emeric CS, et al. Age threshold for primary osteoporosis screening in men. Presented at: American Geriatrics Society Annual Meeting; May 3-5, 2018; Orlando, Florida.
Disclosures: Healio Family Medicine was unable to determine authors’ relevant financial disclosures prior to publication.