Osteoporosis Rarely Diagnosed, Treated Among Older Men with Fractures

Jeffrey Curtis, MD, MS, MPH (UAB)

Osteoporosis remains an under-recognized condition among older males, particularly those who experience fractures, according to new data.

Though the rheumatic condition has become more commonly associated with older women, osteopathic risks still persist for men—and they may be going undetected. A new study presented at the American College of Rheumatology (ACR) Convergence 2020 this week showed screening, diagnosis, and eventual treatment of osteoporosis in older men is significantly low.

Investigators, led by Jeffrey R. Curtis, MD, MS, MPH, of the Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham, sought to assess emerging data which has shown worse outcomes related to osteoporotic fractures among males versus females. As they noted, approximately one-fourth of all patients with fractures are male.

“Osteoporosis is associated with significant burden in terms of adverse patient outcomes, mortality, and cost; and is particularly common in the older Medicare population,” they wrote. “The objective of this study was to examine baseline characteristics of male Medicare patients who experienced a fragility fracture.

Curtis and colleagues studied a population of Medicare fee-for-service beneficiaries with either a closed fragility or osteoporosis-related fracture from January 2010 – September 2014. Patients were ≥65 years old at the index date, with continuous enrollment in the benefit plan and pharmacy benefits for a minimum of 1 year prior to the index date, and at least 1 month afterward.

Investigators excluded patients with Paget’s disease or malignancies outside of non-melanoma skin cancer at baseline.

The patients were classified into 4 cohorts based on their observed diagnoses and/or treatment of osteoporosis at baseline.

Among the observed 9876 beneficiaries to meet criteria, 61% were ≥75 years old, and 90.3% were white. Curtis and colleagues observed that just fewer than 6% of patients had undergone bone mineral density testing with dual-energy X-ray absorptiometry (DEXA) scans in the 2 years prior to their fracture.

Men are generally not sought for routinely recommended DEXA scans, Curtis said in a statement, which may drive the suggested gender disparity in osteoporosis diagnosis.

“While many comorbidities (i.e., cardiovascular disease) are commonly recognized and treated in men, sometimes even more than women, osteoporosis is not one of them,” he explained “There is also a lack of consistent guidelines for osteoporosis screening recommendations for men.”

Commonly observed fracture sites in patients included the spine (31.0%), hip (27.9%), and ankle (9.8%). Nearly 93% (n = 9163) did not have a claim for diagnosis or treatment of osteoporosis at baseline.

Another 2.8% of patients (n = 279) were diagnosed but not treated; 2.3% (n = 227) were treated but not diagnosed; just 2.1% (n = 207) of patients overall were both diagnosed and treated for osteoporosis.

Investigators also observed a trend in declining DEXA scans from 2012-2014, similarly across differing patient age groups (65-69 years, 6.3% vs 5.5%; 70-74 years, 4.7% vs 4.0%), but especially among the oldest population (≥75 years, 6.0% vs 4.3%).

Both diagnosis and treatment of osteoporosis remain a largely unmet need among older men to experience fractures. Curtis and colleagues now aim to document the cost of care associated with unidentified osteoporosis-related fractures: the drivers of high costs, as well as earlier identification high-risk patients who may benefit from targeted screening and preemptive therapies.

Curits also expressed interest in observing what other ailments older men at osteoporosis risk commonly face.

“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,” he said.

The study, “Characterization of Older Male Patients with a Fragility Fracture,” was presented at ACR 2020.