Preventive Care

Men with certain risk factors for osteoporosis should be screened for the condition

Although osteoporosis (low bone mass density, BMD) is considered primarily a problem for older women, a 60-year-old white man has a 25 percent lifetime risk of suffering a bone fracture due to osteoporosis. Osteoporosis, which is typically without symptoms, is substantially underdiagnosed and undertreated among men in the United States. However, a new study reveals certain risk factors for osteoporosis among asymptomatic men that can be used to identify those who should be screened for the problem.

A team of researchers systematically reviewed studies on the topic from 1990 to July 2007. The studies either assessed risk factors for osteoporotic fracture in men or evaluated the gold standard screening test for osteoporosis, the dual-energy x-ray absorptiometry (DXA), against a non-DXA screening test.

The studies revealed that the key risk factors for low BMD-mediated fracture included older age (notable over 70 years), low body weight (body mass index less than 20 to 25 kg/m2), greater than 10 percent weight loss, physical inactivity, prolonged corticosteroid use, previous osteoporotic fracture, and androgen deprivation therapy. Cigarette smoking was associated with lower BMD, but there was less evidence in men to determine its association with fracture.

The studies also showed that non-DXA tests either are too insensitive or have insufficient data to reach conclusions. These tests range from ultrasonography of either heel to the World Health Organization fracture risk algorithm based on clinical risk factors for fracture. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00028).

More details are in "Screening for osteoporosis in men: A systematic review for an American College of Physicians guideline," by Hau Liu, M.D., M.B.A., M.P.H., Neil M. Paige, M.D., M.S.H.S., Caroline L. Goldzweig, M.D., M.S.H.S., and others, in the May 6, 2008, Annals of Internal Medicine 148, pp. 685-701.

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