Men should undergo osteoporosis screening: researcher

Older women have been the object of osteoporosis campaigns for many years. But a new study recommends that selected older men, based on their age and whether they have experienced a fracture, should also undergo screening for the condition.

One-third of all hip fractures occur in men and are associated with as much illness and increased risk of death as those that occur in women, say researchers in a study to be published in the Aug. 8 issue of the Journal of the American Medical Association.

The average 50-year-old Caucasian man has a 13 per cent chance of having a fracture related to osteoporosis sometime in his remaining lifetime. A 60-year-old Caucasian man has a 29 per cent chance.

Even doctors unaware

Yet there is a lack of awareness about the condition in older men on the part of both patients and medical practitioners, says Dr. John Schousboe, director of the osteoporosis centre in Park Nicollet Health Services in Minneapolis.

"Although osteoporosis is certainly much more common in women than in men, as men are aging and as the age structure of the male population in Western society gets older, we're seeing more and more of this," he told CBC News.

Despite the importance of the problem of osteoporosis in men, he says, there is a lack of evidence regarding the cost-effectiveness of common diagnostic and therapeutic interventions.

With that in mind, Schousboe and his colleagues conducted a study to estimate the lifetime costs and health benefits of bone densitometry (a measurement of bone density) followed by five years of oral bisphosphonate (a class of drugs used to strengthen bone) therapy for men found to have osteoporosis.

They then created a computer simulation model for hypothetical groups of white men age 65, 70, 75, 80, or 85 years, with or without a prior clinical fracture. Data from several sources were used to estimate fracture costs and population-based age-specific fracture rates and associations among prior fractures, bone density and incident fractures.

The authors estimated the costs per quality-adjusted life-years (QALYs) gained for the densitometry and followup treatment strategy comparedto no intervention, calculated from lifetime costs and accumulated QALYs for each strategy.

The studyfound that "universal bone densitometry followed by oral bisphosphonate therapy among those found to have osteoporosis for all men aged 70 years or older regardless of fracture history or other fracture risk factors is not cost-effective using current drug costs."

The study nevertheless says this strategy may be cost-effective for men aged 65 years or older with a prior clinical fracture, and for men aged 80 years or older without a prior fracture, assuming a willingness on the part of society to pay $50,000 per QALY gained.

'It's a good thing for society not to ignore fractures in men over age 50, to look into the possibility of treating them to prevent subsequent fractures.' Dr. John Schousboe

Schousboe cautions that the findings don't negate the need for screening of younger men. "The cost to society is still greater than just ignoring the problem. You still spend more money. But for the money you spend, you gain a certain quality of life.

Canadian drug costs a factor

"It's a good thing for society not to ignore fractures in men over age 50, to look into the possibility of treating them to prevent subsequent fractures. It still is a significant public health issue," he says.

In Canada, the argument for earlier screening may be even more compelling, says Schousboe. "In Canada, the wholesale price [of drugs] is two-fifths of what it is here."

He says an assessment of medical care for fractures could also show evidence for earlier screening, though no Canadian data is currently available.

Schousboe also wants more awareness around men's risks for osteoporosis. He says many physicians are unaware of the issue, even when their older male patients turn up with fractures. Or they fall prey to "disease fatigue," meaning that they focus on other more life-threatening conditions like prostate cancer rather than a treatable condition like osteoporosis.

Plus, he says, osteoporosis and its attendant fractures, are accepted by many patients and their doctors as a part of growing old.

"There's a notion that fractures are part of aging and osteoporosis is part of aging." It's a "suck it up and don't complain," mentality,says Schousboe.