“There are men in pain out there, ” is the cry from researchers at Beth Israel Deaconess Medical Center (BIDMC). A new study indicates that we are missing diagnostic and treatment opportunities by not focusing more attention on bone loss and fracture risk in older men. The study, whose results appeared online November 5 in The Journal of Bone and Joint Surgery, utilized data from 2007-2012.
Men’s Osteoporosis Being Ignored, Says Study
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“Given that the prevalence of fragility fractures among men is expected to increase threefold by the year 2050, adequately evaluating and treating men for osteoporosis is of paramount importance, ” said lead author Tamara Rozental, M.D., an investigator in BIDMC’s Department of Orthopedic Surgery, in the November 5, 2014 news release.
“We know that a distal radial fracture can often be an early indication of bone loss. We typically see this type of fracture 10 to 15 years before we might see a hip fracture, ” said Rozental, an associate professor of orthopedic surgery at Harvard Medical School. “When we treat fractures of the wrist, it gives us the opportunity to do a bone mass density (BMD) evaluation and, if necessary, get patients into treatment with the goal of preventing more serious injury, like a hip fracture down the line.”
This study found that following a wrist fracture, 53% of women received Dual X-ray Absorptiometry, while only 18% of men received the same test. Additionally, 21% of men versus 55% of women initiated treatment with calcium and vitamin D supplements within six months of injury, and 3% of men versus 22% of women started taking bisphosphonates.
“Treating men for bone fractures, but not the underlying cause, places them at a greater risk for future bone breaks and related complications, ” said Rozental. “The results of this study lead us to suggest that men over the age of 50 with fractures of the distal radius should undergo further clinical assessment and bone density testing to better identify those at high risk for future fracture as well as those who would benefit from further treatment.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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