SAT-529 Practice Patterns in the Treatment of Male Osteoporosis

Abstract

Introduction: Although osteoporosis in men is now recognized as a significant public health issue, it still remains undertreated. Despite guidelines recommending treatment for men at high risk for fracture, including those with osteopenia (T-score between -1.0 and -2.5) and a Fracture Risk Assessment Tool (FRAX) score ≥3% for a hip fracture or ≥ 20% for any fracture, little is known about physician practice patterns regarding osteoporosis treatment in men. Methods: We conducted a nationwide survey of physician members of the Endocrine Society, American Academy of Family Practice and American Geriatrics Society. We used the modified Dillman method of survey administration. Respondents were asked to identify scenarios for which they were likely to initiate treatment for osteoporosis in their male patients. We conducted a multivariable logistic regression analysis controlling for physician characteristics to identify correlates of treatment initiation for a man aged ≥50 years with a T score -1.7 and FRAX score 3.2% for a hip fracture. Results: Response rate was 63% (359/566). The majority of respondents reported that they often to almost always prescribe bisphosphonates for treatment of osteoporosis in men (75%). Overall, 76% of respondents reported that they would treat a male patient with a recent non-traumatic fracture and 71% stated that they would treat a male patient with prolonged use of steroids. While the majority of the respondents reported that they would treat a male patient aged ≥50 years with a T-score -2.8 (87%), only 37% reported they would treat a male patient aged ≥50 years with a T-score -1.7 and FRAX score 3.2% for hip fracture. In multivariable analysis, primary care physicians and geriatricians were less likely to initiate treatment in this latter scenario compared to endocrinologists (odds ratio (OR) 0.40, 95% confidence interval (CI) 0.21-0.74; OR 0.31, 95% CI 0.17-0.59, respectively). Additionally, physicians with >20 years in practice were also less likely to initiate treatment for the same scenario (OR 0.36, 95% CI 0.19-0.70). Practice setting, male patient volume and whether physicians read guidelines were not significantly associated with treatment initiation in this scenario. Conclusions: We found that primary care physicians, geriatricians and physicians with >20 years in practice are less likely to treat men with osteopenia at a high risk for fractures based on their FRAX score. These findings emphasize that continued efforts are needed to mitigate undertreatment of osteoporosis in men and improve patient care.