Screening For Osteoporosis In Men Research Articles

Population based screening for osteoporosis in men among 40 and 80 years in the brazilian state of Roraima"

The main objective of this study was to conduct population screening for osteoporosis in men between the ages of 40 and 80 in the Boa Vista, the capital of the Brazilian state of Roraima. The population study conducted in this study was basically based on the Fracture Risk Assessment Tool (FRAX®) nomogram model proposed by the World Health Organization (WHO). Specifically, the current work focuses on (i) analyzing the serum concentrations of calcium, vitamin D and total testosterone in relation to the risk of bone event by the FRAX® nomogram and (ii) correlating cardiovascular risk by calculating Framingham score with the FRAX® nomogram. This cohort, and cross-sectional study involves both quantitative and qualitative data obtained in the field from 380 patients. The data obtained were compared to the pre-existing data collected through different bibliography. For the sampling, a cluster method was utilized. Patients with immediate need of health services were referred to the state hospital of Coronel Mota, Boa Vista. This project was approved by the Ethical Committee (number: 50207115.7.0000.5301). While commuting to work or travel around found to be the major reason of the fractures, we observed that older people and people who were involved in physical activities inside a gymnasium had considerably high at risk of fractures. FRAX and TBS femur score (Trabecular Bone Score) was higher for people with fractures. People having lumbar osteopenia and femur osteopenia had higher risk of TBS femur fractures while people having lumbar osteoporosis had higher risk of TBS (femur and hip) as well as FRAX femur factures. All the data obtained in this study were analyzed using SPSS version 21 and a p value of ≤0.05 was considered as statistically significant. Key risk factors for fracture include increased age, physical activities in a gymnasium, lumbar and femur osteopenia and lumbar osteoporosis.

Evaluating Male Patients’ Understanding of Osteoporosis Evaluation and Treatment Following a Distal Radius Fracture

Current estimates suggest that 1-2 million men in the United States have osteoporosis, yet the majority of osteoporosis literature focuses on postmenopausal women. Our aim was to understand men's awareness and knowledge of osteoporosis and its treatment. Semistructured interviews were conducted with 20 male patients >50 years old who sustained a low-energy distal radius fracture. The goal was to ascertain patients' knowledge of osteoporosis, its management, and experience discussing osteoporosis with their primary care physicians (PCP). Participants had little knowledge of osteoporosis or its treatment. Many participants regarded osteoporosis as a women's disease. Most participants expressed concern regarding receiving a diagnosis of osteoporosis. Several patients stated that they believe osteoporosis may have contributed to their fracture. Families, friends, or mass media served as the primary information source for participants, but few had good self-reported understanding of the disease itself. The majority of participants reported never having discussed osteoporosis with their PCPs although almost half had received a dual x-ray absorptiometry scan. Participants expressed general interest in being tested/screened and generally were willing to undergo treatment despite the perception that medication has serious side effects. One patient expressed concern that treatment side effects could be worse than having osteoporosis. Critical knowledge gaps exist regarding osteoporosis diagnosis and treatment in at-risk male patients. Specifically, most patients were unaware they could be osteoporotic because of the perception of osteoporosis as a women's disease. Most patients had never discussed osteoporosis with their PCP. Male patients remain relatively unaware of osteoporosis as a disease entity. Opportunity exists for prevention of future fragility fractures by improving communication between patients and physicians regarding osteoporosis screening in men following low-energy distal radius fractures.

LBSAT139 Osteoporosis Screening In Men As Per Endocrine Society Clinical Practice Guidelines: A Cross-sectional Study

Abstract Introduction With the aging of the population, osteoporosis in men is a significant public health problem. Both hip and vertebral fractures are associated with increased mortality in men, as compared to women. One out of every five men experiences fragility fractures at least once in their lifetime. Declining sex steroid levels and bioavailable estradiol levels contributes to age-related bone loss in men. The objective of this study was to identify the underdiagnosis and the lack of guideline-based screening for osteoporosis in men. Method: Endocrine Society Clinical Practice Guidelines published in June 2012 recommends screening for osteoporosis in all men aged ≥70y, and all men aged between 50-69y who have risk factors including delayed puberty, hypogonadism, hyperparathyroidism, hyperthyroidism, chronic obstructive pulmonary disease; drugs such as glucocorticoids or GnRH agonists; life choices such as alcohol abuse or smoking; or other causes of secondary osteoporosis, using a dual-energy x-ray absorptiometry (DXA) of the spine and hip. The National Osteoporosis Foundation has similar recommendations. | Using a cross-sectional study design, charts of male patients eligible for osteoporosis screening, between the period of September 2020 to December 2021, were reviewed. Patients seen in the internal medicine residents’ clinic, family medicine residents’ clinic and endocrinology clinic were included in the study. Results A total of 90 out of the 1120 male patients aged ≥70y had ever undergone a DXA scan. Of these 90 patients, on reviewing their problem list from the electronic health record, 15 had osteoporosis listed and 9 had fragility fracture/compression fracture/fracture listed. Of the 135 patients aged ≥50y with ho HIV, only 21 received a DXA scan. Additionally, it was observed that only 20% (23/120) of the patients on testosterone therapy were screened for osteoporosis. As compared to this, almost 40% (1012 out of 2479) of all women aged ≥65y received screening DXA scan. Conclusion This project highlighted the inconsistencies in ordering screening DXA scans for male patients at risk for osteoporosis. Fewer than 10% of the at-risk males had a DXA. Additionally, 10% of the patients who underwent DXA had already suffered from a fracture, further emphasizing the burden of this disease. Although osteoporosis is appreciated in post-menopausal women, we must not overlook our male patients, who have 2-3 times higher morbidity and mortality associated with a hip fracture. Based on this data, we plan to initiate a quality improvement project with an aim to improve guideline directed screening for osteoporosis. Enhanced DXA screening for at risk patients will not only reduce rates of fragility fracture but will also help reduce healthcare cost. For a sustainable and broader impact, we are working further on EPIC Best Practice Alert to prompt providers to order DXA scans for these patients. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Protocol for the models of primary osteoporosis screening in men (MOPS) cluster randomized trial

Current guidelines recommend primary osteoporosis screening for at-risk men to reduce the morbidity, mortality, and cost associated with osteoporotic fractures. However, analyses in a national Veterans Health Administration cohort of over 4,000,000 men demonstrated that primary osteoporosis screening as it is currently operationalized does not benefit most older Veterans due to inefficient targeting and low subsequent treatment and adherence rates. The overall objective of this study is to determine whether a new model of primary osteoporosis screening reduces fracture risk compared to usual care. We are conducting a pragmatic group randomized trial of 38 primary care teams assigned to usual care or a Bone Health Service (BHS) screening model in which screening and adherence activities are managed by a centralized expert team. The study will: 1) compare the impact of the BHS model on patient-level outcomes strongly associated with fracture rates (eligible proportion screened, proportion meeting treatment criteria who receive osteoporosis medications, medication adherence, and femoral neck bone mineral density); 2) quantify the impact on provider and facility-level outcomes including change in DXA volume, change in metabolic bone disease clinic volume, and PACT provider time and satisfaction; and 3) estimate the impact on health system and policy outcomes using Markov models of screening program cost per quality adjusted life year based from health system and societal perspectives.

Understanding Osteoporosis Screening Practices in Men: A Nationwide Physician Survey

To understand osteoporosis screening practices, particularly in men, by a diverse cohort of physicians, including primary care physicians, endocrinologists, and geriatricians. We surveyed randomly selected members of the American Academy of Family Practice, Endocrine Society, and American Geriatrics Society. Respondents were asked to rate how often they would screen for osteoporosis in four different clinical scenarios by ordering a bone density scan. Multivariable logistic regression analyses were conducted to determine factors associated with offering osteoporosis screening in men in each clinical scenario. Physicians were also asked to note factors that would lead to osteoporosis screening in men. Response rate was 63% (359/566). While 90% respondents reported that they would always or frequently screen for osteoporosis in a 65-year-old post-menopausal woman, only 22% reported they would screen a 74-year-old man with no significant past medical history. Endocrinologists were more likely to screen a 74-year-old man compared to primary care physicians (odds ratio, 2.32; 95% confidence interval, 1.10 to 4.88). In addition to chronic steroid use (94%), history of nontraumatic fractures (88%), and androgen-deprivation therapy for prostate cancer (82%), more than half the physicians reported suppressive doses of thyroid hormone (64%) and history of falls (52%) as factors leading to screening for osteoporosis in men. Our survey results highlight heterogeneity in osteoporosis screening in men, with underscreening in some scenarios compared to women, and identify factors that lead to screening in men. These findings can help design interventions to improve osteoporosis screening in men.

Effectiveness of Osteoporosis Self-Assessment Tool for Asians in Screening for Osteoporosis in Healthy Males Over 40 Years Old in China

In this study, we evaluated the effectiveness of the Osteoporosis Self-assessment Tool for Asians (OSTA) in screening for osteoporosis in the elderly male population in the Chengdu area, China. The Lunar Prodigy Advance bone densitometer was used to measure the bone mineral density of 11,039 healthy males over the age of 40 years. Men with OSTA scores of >−1, −4 < OSTA ≤ −1, or ≤−4 were assigned to the low-risk, moderate-risk, or high-risk group, respectively. The T-scores measured with dual-energy X-ray absorptiometry at the different sites were compared across the groups. The bone mineral density of the lumbar spines L1–L4, the left femur, and other sites decreased gradually with age. With increasing age, the screening sensitivity of OSTA for osteoporosis in the lumbar spine and femur gradually increased, whereas its specificity decreased. The areas under the receiver operating characteristic curves for the OSTA index in different age groups and at different sites were 0.644–0.831. Therefore, the OSTA index demonstrated some value in screening for osteoporosis in men over the age of 50 years. Significant differences in its effectiveness were observed among different age groups.

Bone Density Screening and Re-screening in Postmenopausal Women and Older Men.

Clinical practice guidelines universally recommend bone mineral density (BMD) screening to identify osteoporosis in women aged 65 years and older. Risk assessment is recommended to guide BMD screening in postmenopausal women under age 65. Insufficient data are available to inform standard ages to start and stop BMD screening in postmenopausal women. Based on longitudinal studies of incident osteoporosis and fracture in postmenopausal women, an initial BMD test should be ordered for all women aged 65, and the frequency of re-screening should be based on age and BMD T score (more frequent testing for older age and lower T score). Although clinical practice guidelines recommend BMD screening according to risk factors for fracture in postmenopausal women under age 65, no standard approach to risk assessment exists. Minimal evidence is available to guide osteoporosis screening in men, but some experts recommend initiation of BMD screening in men at age 70.

Abstract #502: Rate of Osteoporosis Screening in Men vs Women in an Academic Outpatient Internal Medicine Clinic

Abstract #502: Rate of Osteoporosis Screening in Men vs Women in an Academic Outpatient Internal Medicine Clinic

The Male Osteoporosis Risk Estimation Score and the Osteoporosis Self-Assessment Screening Tool for Indonesian Men

To evaluate the male osteoporosis risk estimation score (MORES) and the osteoporosis self-assessment screening tool (OST) score as a means of screening for osteoporosis in men. Records of 113 Indonesian men aged 50 to 91 (mean, 71) years who underwent evaluation of bone mineral density (T-score) using Dual-energy X-ray absorptiometry were retrospectively reviewed. The MORES was determined by 3 osteoporosis risk factors: age (in years), body weight (in kg), and chronic obstructive pulmonary disorder. A MORES of ≥6 indicated osteoporosis and corresponded to a T-score of ≤-2.5. The OST score was calculated as body weight (in kg) minus age (in years) multiplied by 0.2. An OST score of ≤2 indicated osteoporosis and corresponded to a T-score of ≤-2.5. Sensitivity, specificity, and positive and negative predictive values of the MORES and the OST score were determined. Respectively for the MORES and the OST score, sensitivity values were 100% and 74%, specificity values were 7% and 41%, positive predictive values were 25% and 28%, and negative predictive values were 100% and 83%. Using receiver operating characteristic curves, the area under curve was 0.535 for the MORES and 0.574 for the OST score. The MORES and the OST score should be used together to screen for osteoporosis in men.

Screening for Osteoporosis in Men Receiving Androgen Deprivation Therapy

Screening for Osteoporosis in Men Receiving Androgen Deprivation Therapy

Screening for Osteoporosis: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for osteoporosis. The USPSTF evaluated evidence on the diagnostic accuracy of risk assessment instruments for osteoporosis and fractures, the performance of dual-energy x-ray absorptiometry and peripheral bone measurement tests in predicting fractures, the harms of screening for osteoporosis, and the benefits and harms of drug therapy for osteoporosis in women and men. The USPSTF recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. (Grade B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men. (I statement).

Management Strategies for Osteoporosis in the Aging Male: Focus on Zoledronic Acid

Osteoporosis in men is an increasingly important clinical issue, that actually remains under-recognized and undertreated. Moreover there is no validated strategy for a systematic osteoporosis screening in men and decisions regarding treatment should be based on the absolute risk of fracture. Among the different treatment options, bisphosphonate therapy is becoming a mainstay in the treatment of male osteoporosis, even though evidence for the long-term efficacy and safety of therapies for osteoporosis in men remains limited. In this review, we report the current evidence on the use of zoledronic acid, a potent aminobisphosphonate that can be administered intravenously, for the prevention and treatment of osteoporosis in men.

Total estradiol, rather than testosterone levels, predicts osteoporosis in aging men

To study and establish sex hormone cutoff levels for osteoporosis risk in men over 50 years old. Case-control study of 216 men > 50 years, 110 with osteoporosis (O) and 106 with normal bone density (C). We measured estradiol (E2), sex hormone binding globulin (SHBG), total testosterone (TT) and albumin. Free testosterone (FT) and bioavailable testosterone (BT) were calculated through Vermeulen's formula. There was no difference in TT between groups. Relative risks of osteoporosis were 1.89 for E2 < 37 pg/mL (p = 0.02); 1.91 for SHBG > 55 nmol/L (p = 0.019); 2.5 for FT < 7 ng/dL (p = 0.015); 2.7 for BT < 180 ng/dL (p = 0.0003). In men over 50 years old, TT was not indicative of osteoporosis risk while E2 < 37 ng/mL was. SHBG > 55 nmol/L, FT < 7 ng/dL and BT < 180 ng/dL can represent additional indications for osteoporosis screening in men over 50 years old.

The Frequency of Osteoporosis Screening in Men With Inflammatory Bowel Disease

Osteoporosis is underdiagnosed in men, and osteoporosis-related fractures carry high morbidity and mortality. Recent recommendations on osteoporosis screening in men from the American College of Physicians state that screening and risk factor assessment need to occur earlier in men at high risk. Men with inflammatory bowel disease are at high risk for osteoporosis and fragility fractures due to corticosteroid use, malabsorption from intestinal resection, potential vitamin D deficiency, and fluctuations in weight. This study examines the rate of corticosteroid use, vitamin D screening, and bone mineral density screening of men with inflammatory bowel disease in a gastroenterology practice. The vast majority of men with inflammatory bowel disease are at high risk for osteoporosis. Screening and risk factor assessment should be emphasized.

Screening for osteoporosis in men: comment on the American College of Physicians clinical guidelines

Screening for osteoporosis in men: comment on the American College of Physicians clinical guidelines

Correction: Screening for Osteoporosis in Men

Correction: Screening for Osteoporosis in Men

Screening for Osteoporosis in Men: A Clinical Practice Guideline from the American College of Physicians

The American College of Physicians developed this guideline to present the available evidence on risk factors and screening tests for osteoporosis in men. Published literature on this topic was identified by using MEDLINE (1990 to July 2007). Reference mining was done on the retrieved articles, references of previous reviews, and solicited articles from experts. The inclusion criteria for the studies were measuring risk factors for low bone mineral density or osteoporotic fracture in men or comparing 2 different methods of assessment for the presence of osteoporosis in men. This guideline grades the evidence and recommendations by using the American College of Physicians' clinical practice guidelines grading system. RECOMMENDATION 1: The American College of Physicians recommends that clinicians periodically perform individualized assessment of risk factors for osteoporosis in older men (Grade: strong recommendation; moderate-quality evidence). RECOMMENDATION 2: The American College of Physicians recommends that clinicians obtain dual-energy x-ray absorptiometry for men who are at increased risk for osteoporosis and are candidates for drug therapy (Grade: strong recommendation; moderate-quality evidence). RECOMMENDATION 3: The American College of Physicians recommends further research to evaluate osteoporosis screening tests in men.

Screening for Osteoporosis in Men: A Systematic Review for an American College of Physicians Guideline

Screening for low bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) is the primary way to identify asymptomatic men who might benefit from osteoporosis treatment. Identifying men at risk for low BMD and fracture can help clinicians determine which men should be tested. To identify which asymptomatic men should receive DXA BMD testing, this systematic review evaluates 1) risk factors for osteoporotic fracture in men that may be mediated through low BMD and 2) the performance of non-DXA tests in identifying men with low BMD. Studies identified through the MEDLINE database (1990 to July 2007). Articles that assessed risk factors for osteoporotic fracture in men or evaluated a non-DXA screening test against a gold standard of DXA. Researchers performed independent dual abstractions for each article, determined performance characteristics of screening tests, and assessed the quality of included articles. A published meta-analysis of 167 studies evaluating risk factors for low BMD-related fracture in men and women found high-risk factors to be increased age (>70 years), low body weight (body mass index <20 to 25 kg/m2), weight loss (>10%), physical inactivity, prolonged corticosteroid use, and previous osteoporotic fracture. An additional 102 studies assessing 15 other proposed risk factors were reviewed; most had insufficient evidence in men to draw conclusions. Twenty diagnostic study articles were reviewed. At a T-score threshold of -1.0, calcaneal ultrasonography had a sensitivity of 75% and specificity of 66% for identifying DXA-determined osteoporosis (DXA T-score, -2.5). At a risk score threshold of -1, the Osteoporosis Self-Assessment Screening Tool had a sensitivity of 81% and specificity of 68% to identify DXA-determined osteoporosis. Data on other screening tests, including radiography, and bone geometry variables, were sparse. Key risk factors for low BMD-mediated fracture include increased age, low body weight, weight loss, physical inactivity, prolonged corticosteroid use, previous osteoporotic fracture, and androgen deprivation therapy. Non-DXA tests either are too insensitive or have insufficient data to reach conclusions.

Screening for Osteoporosis in Men: Recommendations from the American College of Physicians

Screening for Osteoporosis in Men: Recommendations from the American College of Physicians

Osteoporosis during androgen deprivation therapy for prostate cancer

Osteoporosis is an important complication of androgen deprivation therapy (ADT). ADT by either orchiectomy or treatment with a gonadotropin-releasing hormone agonist decreases bone mineral density and increases fracture risk. Other factors, including diet and lifestyle, may contribute to bone loss in men with prostate cancer. Routine osteoporosis screening in men with prostate cancer is appropriate based on the high prevalence of osteoporosis. There is limited information about the best strategy to treat or prevent bone loss during ADT. Lifestyle modification, including smoking cessation, moderate alcohol consumption, and regular weight-bearing exercise should be encouraged. Supplemental calcium and vitamin D are also recommended. Additional treatment is warranted for men with osteoporosis, fractures, or high rates of bone loss during ADT. Pamidronate, an intravenous bisphosphonate, prevents bone loss during ADT. Other bisphosphonates are probably effective, although they have not been evaluated in this clinical setting. Alternative forms of hormonal therapy, including bicalutamide monotherapy, may cause less bone loss than ADT.