Studies consistently show substantially lower rates of osteoporosis screening in men vs women. One study of 8262 patients found that DXA screenings occurred in only 18.4% of men who were eligible for inclusion in the study based on age, compared with 60% of women.18 Results of other studies revealed that 27% of women with a hip fracture had been screened for osteoporosis within the previous 5 years vs 11% of men.17
This may be partially explained by the “older age of onset, the high amount of comorbidities that such patients may have, the physician’s and patient’s lack of awareness, and the insurance coverage,” as stated in the review.2 Screening recommendations from professional organizations are inconsistent or unclear, which may be another reason for the discrepancy, although most guidelines recommend that all male patients ≥70 years be screened.
“One of the barriers to discussing male osteoporosis is the fact that it is still thought of as a ‘female’ disease by both patients and some healthcare providers,” Dr Peoples added. “It is important to consider a diagnosis of osteoporosis in both women and men as they age — in particular, careful attention [must be paid] to screening men with risk factors for osteoporosis.”
The central DXA scan, which measures bone density at the hip, distal radius, and spine, is the most validated tool for osteoporosis screening and for predicting the risk of future fractures in both men and women. Another widely used tool for predicting fracture risk is the Fracture Risk Assessment Tool (FRAX), although it may underestimate the risk in men vs women.19
“Regardless of sex, patients with osteoporosis need to have improved treatment rates, and a great deal of additional study is needed for male osteoporosis in regard to the disease course itself, clear screening guidelines, and treatment effectiveness,” said Dr Peoples. For example, while bisphosphonates are recommended in men with osteoporosis, the specific male response to these and other interventions is unclear because most treatment trials have consisted primarily of women. Further research is also warranted regarding prevention of fractures in men and improved treatment following fracture.
“Given that rheumatologists are specialists playing key roles in the treatment of the aging population, it is important for them to realize the disparities in prevention, screening, and treatment of male osteoporosis,” Dr Peoples noted. “Patient education regarding male osteoporosis is critical in allowing for a broadening discussion of male osteoporosis screening, treatment, and complications.”
- Reginster JY, Burlet N. Osteoporosis: a still increasing prevalence. Bone. 2006;38(2 Suppl 1):S4-S9. doi:10.1016/j.bone.2005.11.024
- Alswat KA. Gender disparities in osteoporosis. J Clin Med Res. 2017;9(5):382-387. doi:10.14740/jocmr2970w
- Avdagic SC, Baric IC, Keser I, et al. Differences in peak bone density between male and female students. Arh Hig Rada Toksikol. 2009;60(1):79-86. doi:10.2478/10004-1254-60-2009-1886
- Lu PW, Cowell CT, SA LL-J, Briody JN, HowmanGiles R. Volumetric bone mineral density in normal subjects, aged 5-27 years. J Clin Endocrinol Metab. 1996;81(4):1586-1590. doi:10.1210/jcem.81.4.8636372
- Seeman E. Pathogenesis of bone fragility in women and men. Lancet. 2002;359(9320):1841-1850. doi:10.1016/S0140-6736(02)08706-8
- Jones G, Nguyen T, Sambrook P, Kelly PJ, Eisman JA. Progressive loss of bone in the femoral neck in elderly people: longitudinal findings from the Dubbo osteoporosis epidemiology study. BMJ. 1994;309(6956):691-695.
- Hannan MT, Felson DT, Dawson-Hughes B, et al. Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res. 2000;15(4):710-720. doi:10.1359/jbmr.2000.15.4.710
- Falahati-Nini A, Riggs BL, Atkinson EJ, O’Fallon WM, Eastell R, Khosla S. Relative contributions of testosterone and estrogen in regulating bone resorption and formation in normal elderly men. J Clin Invest. 2000;106(12):1553-1560. doi:10.1172/JCI10942
- Gennari L, Khosla S, Bilezikian JP. Estrogen and fracture risk in men. J Bone Miner Res. 2008;23(10):1548-1551. doi:10.1359/jbmr.0810c
- Seeman E. During aging, men lose less bone than women because they gain more periosteal bone, not because they resorb less endosteal bone. Calcif Tissue Int. 2001;69(4):205-208. doi:10.1007/s00223-001-1040-z
- van Staa TP, Dennison EM, Leufkens HG, Cooper C. Epidemiology of fractures in England and Wales. Bone. 2001;29(6):517-522. doi:10.1016/S8756-3282(01)00614-7
- Cooper C, Melton LJ, 3rd. Epidemiology of osteoporosis. Trends Endocrinol Metab. 1992;3(6):224-229. doi:10.1016/1043-2760(92)90032-V
- Forsén L, Sogaard AJ, Meyer HE, Edna T, Kopjar B. Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteoporos Int. 1999;10(1):73-78.
- Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B. Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing. 2010;39(2):203-209. doi:10.1093/ageing/afp221
- Wehren LE, Hawkes WG, Orwig DL, Hebel JR, Zimmerman SI, Magaziner J. Gender differences in mortality after hip fracture: the role of infection. J Bone Miner Res. 2003;18(12):2231-2237. doi:10.1359/jbmr.2003.18.12.2231
- Antonelli M, Einstadter D, Magrey M. Screening and treatment of osteoporosis after hip fracture: comparison of sex and race. J Clin Densitom. 2014;17(4):479-483. doi:10.1016/j.jocd.2014.01.009
- Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH. Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med. 2002;162(19):2217-2222. doi:10.1001/archinte.162.19.2217
- Alswat K, Adler SM. Gender differences in osteoporosis screening: retrospective analysis. Arch Osteoporos. 2012;7:311-313. doi:10.1007/s11657-012-0113-0
- Sandhu SK, Nguyen ND, Center JR, Pocock NA, Eisman JA, Nguyen TV. Prognosis of fracture: evaluation of predictive accuracy of the FRAX algorithm and Garvan nomogram. Osteoporos Int. 2010;21(5):863-871. doi:10.1007/s00198-009-1026-7