Osteoporosis in Men and Fracture Risk

Diagnostic Methods and Current Screening Guidelines

There are two ways to diagnose osteoporosis;  bone density testing and after-the-fact of a fragility fracture.  Bone density testing (DXA; dual energy x-ray absorptiometry) screening is, and has been, recommended for women age 65 or older and for those younger with known risk factors.  In contrast, there are minimal recommendations for men.

Diagnostic Methods and Current Screening Guidelines

Men generally experience an increased fracture risk 5-10 years later than women but have a higher rate of complications and death.  Men are twice as likely as women to die after a hip fracture with 37% dying within one year.  Approximately 30% of hip fractures are currently experienced by men.  I speculate that this number will rise due to the increasing use of bone wasting medications and ubiquitous poor lifestyle choices.

The Research Bias Problem

The reason men are often overlooked in regard to osteoporosis comes down to research.  This is analogous to how heart disease research historically included far more men than women.   Osteoporosis research has focused on women.

Clinical Implications

The bottom line is that although osteoporosis is seen more often and at a younger age in women, many men need prevention and treatment also.  Better to suggest a DXA test than to have your male patients suffer an avoidable fracture.

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