Osteoporosis 'largely ignored' in older men
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Less than 3% of older men who had experienced an osteoporosis-related fracture had been properly diagnosed and treated, according to findings presented at ACR Convergence 2020.
“Osteoporosis is a debilitating disease and it carries with it significant morbidity and mortality,” Jeffrey R. Curtis, MD, MS, MPH, professor of medicine in the division of immunology and rheumatology at the University of Alabama at Birmingham, said in a press conference. “But it is often misconstrued as a disease that really mainly, if not only, affects Caucasian women, which is, in fact, not the case.”
Some 20% to 25% of osteoporosis-related fractures occur in men, according to Curtis. “The idea here was to figure out [whether] people recognize the risk factors of fractures, falls and the like and doing something about it ahead of time to try to mitigate that risk,” Curtis said.
The group investigated a cohort of 9,876 Medicare fee-for-service male beneficiaries who had experienced a closed fragility or osteoporosis-related fracture over the period between Jan. 1, 2010 and Sept. 30, 2014.
Eligible participants were aged older than 65 years, had ongoing enrollment in Medicare fee-for-service plans that included parts A, B, D-C medical and pharmacy benefits for a full year prior to the index date and at least one month after.
Baseline data showed that 61% of the cohort was 75 years or older, while 90.3% of participants were white.
Bone mineral density testing with dual energy X-ray absorptiometry in the 2 years before fracture had been performed in fewer than 6% of participants. Similarly, 92.8% of patients with a qualifying fracture did not have a claim for a diagnosis or treatment of osteoporosis at baseline, according to the results.
Curtis and colleagues grouped these older men who had experienced an osteoporosis-related fracture into one of four groups: those who had been diagnosed, those who had been treated, those who had been both diagnosed and treated and those who had neither been diagnosed nor treated.
Results showed that 2.8% were diagnosed but not treated. Only 2.3% were treated but not diagnosed, an outcome Curtis described as “only slightly better than the reverse.”
Overall, just 2.1% of these individuals with osteoporotic fractures were both diagnosed and treated accordingly.
Other findings showed that a history of musculoskeletal pain was reported in 62.8% of the group, while 48.5% had a history of opioid use in the year before their index fracture.
Spine fractures occurred in 31.0% of patients, while 27.9% experienced hip fractures and 9.8% had ankle fractures.
DXA scans declined between 2012 and 2014 among patients aged 65-69 years (from 6.3% to 5.5%), those aged 70-74 years (from 4.7% to 4.0%) and for those aged 75 years or older (from 6.0% to 4.3%). “The underutilization of DXA testing was actually getting a bit worse, not better, over time,” Curtis said.
A further distressing result, for Curtis, was that once patients had been properly diagnosed, the treatment patterns were “not much better.” Just 12% of patients underwent proper BMD testing in the year following their fracture. “Only 9% were treated with an osteoporosis medication,” he said of this period, as well.
“Importantly, about 7% of the men in this cohort went on to have one or more fractures in the next year,” Curtis added.
Curtis attempted to explain the findings. One issue is that clinicians are failing to recognize fractures and falls and aren’t screening men appropriately. Another is the “silent” nature of the disease, meaning that it can progress largely unnoticed.
Ongoing prevention is also problematic, according to Curtis. “Even if they break bones, they may just not know enough how to prevent their next fracture,” he said.
“It is quite clear from these results that men are being largely ignored when it comes to osteoporosis,” Curtis concluded.
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Curtis J. Abstract #533. Presented at: ACR Convergence 2020; November 5-9, 2020 (virtual meeting).
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