Osteoporosis is being Underdiagnosed, Undertreated in Older Men

Jeffrey Curtis, MD, MS, MPH

New research from the American College of Rheumatology annual meeting is sounding the alarm on an unsettling trend regarding the care of older male patients.

Data from the study, which was led by investigators at the University of Alabama at Birmingham, indicates older men who experience a fracture are still underdiagnosed and undertreated for osteoporosis.

“Men are typically not part of routinely recommended screening with dual-energy X-ray absorptiometry (DXA) and so they are both underdiagnosed and undertreated. While many comorbidities are commonly recognized and treated in men, sometimes even more than women, osteoporosis is not one of them. Even post fracture for major fractures like a hip, rates of treatment are disappointingly low, leaving men at risk for yet another fracture,” said study investigator, Jeffrey Curtis, MD, MS, MPH, Professor of Medicine, Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham, in a statement.

Posing a substantial burden to the quality of life and overall health of patients, identifying and treating osteoporosis is an integral part of care for older patients. However, many major organizations fail to include male patients in guidelines or recommendations for osteoporosis screenings.

With this in mind, Curtis and a team of colleagues sought to define the prevalence of osteoporosis screenings and treatment using a population of Medicare fee-for-service (FFS) beneficiaries. For inclusion in the analysis, patients were required to have had a closed-fragility or osteoporosis-related fracture between January 2010-September 2014, be 65 or older at the time of the index date, and be continuously enrolled in Medicare FFS with medical and pharmacy benefits for a minimum of 1 year after the index date through at least 1 month after.

Patients were excluded from the study if they died within 30 days of the index date or if they had either Paget’s disease or any malignancy, except non-melanoma skin cancer, at baseline.

In total, investigators identified 9876 beneficiaries for inclusion in their study. This population was 90% white, 61% were 75 years of age or older, and less than 6% had undergone a bone mineral density (BMD) test with DXA in the 2 years leading up to their fracture. For the purpose of analysis, patients were divided into 4 groups based on diagnoses and/or treatment of osteoporosis at baseline.

Upon analysis, investigators found 62.8% of patients had a history of musculoskeletal pain and 48.5% had a history of opioid use 1 year prior to their index fracture. The most common fracture sites were spine (31.0%), hip (27.9%), and ankle (9.8%). Among those included in the study, 92.8% did not have a claim for diagnosis or treatment of osteoporosis at baseline.

Additionally, 2.8% were diagnosed but not treated, 2.3% were treated but not diagnosed, and 2.1% were diagnoses and treated. Investigators also noted a trend in declining DXA scans from 2012-2014 (65-69 years, 6.3 to 5.5%; 70-74 years, 4.7 to 4.0%) with this trend being even more pronounced in those 75 or older (6.0 to 4.3%).

In the aforementioned statement, Curtis underlined the impact earlier identification could have among this patient population.

“Incorporation of these recommendations in quality-of-care measures for osteoporosis management and post-fracture care are warranted to improve health outcomes in this population. As for the next steps for research in this area, there is a need for better characterization of high-risk patients including existing comorbidities that may have shared etiology or risk factors that may enable earlier identification and treatment,” added Curtis.

This study, “Characterization of Older Male Patients with a Fragility Fracture,” was presented at ACR Convergence.