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November 05, 2014

Older men less likely to receive osteoporosis screening and treatment following a bone fracture

Discrepancy increases risk for future bone breaks, related complications
 

ROSEMONT, Ill.—Osteoporosis, a common condition causing progressive bone loss and increased fracture risk, is primarily thought of as a disease affecting older women. And yet, up to one in four men over age 50 will break a bone due to osteoporosis. A study in the November issue of the Journal of Bone & Joint Surgery (JBJS) found that men were three times less likely than women to undergo bone mass density (BMD) testing following a broken wrist (distal radius fracture) and seven times less likely to begin treatment for osteoporosis.

With an aging U.S. population, the likely incidence of fragility fractures ? occurring during a fall from a standing or lower position, typically due to bone loss ? is expected to increase two to fourfold in men and women over the next 30 years. More than 2 million men currently have osteoporosis, and more than 30 percent of hip fractures occur in men. Men have twice the mortality rate of women during the initial hospitalization and first post-fracture year following a hip fracture. Survival rates following a wrist fracture, the third most common fragility fracture and the number one upper extremity fracture in older adults, also are lower among men.

A BMD evaluation, often with Dual-Energy X-ray Absorptiometry (DXA) imaging, is standard care for women over the age of 65, and for those over age 60 who have suffered a fragility fracture or have osteoporosis risk factors. Similar recommendations have been proposed for men.

In this study, researchers retrospectively reviewed the medical records of 95 men and 344 women over the age of 50 who were treated for a wrist fracture at a single institution between 2007 and 2012. Patient injuries were assessed to determine whether or not they were screened for osteoporosis before their injury and/or if they received a DXA scan and osteoporosis treatment within six months following their wrist fracture.

Fewer men than women underwent BMD testing prior to their fracture. Following the wrist fracture, the number of men undergoing osteoporosis assessment continued to be lower: 53 percent of women (184) versus 18 percent of men (17). In addition:
 
  • Twenty-one percent of men versus 55 percent of women initiated treatment with calcium and vitamin D supplements within six months of injury, and three percent of men versus 22 percent of women started taking bisphosphonates, a common drug treatment for increasing bone mass.
  • Male sex, less severe fracture patterns and high-energy mechanism of injury were independent predictors of failure to initiate treatment with calcium and vitamin D.
  • Using the World Health Organization (WHO) online Fracture Risk Assessment Tool (FRAX), 50 percent of men who obtained a bone density test were deemed at risk for a second major osteoporotic fracture in the next decade.
  • Overall, the men had less severe fractures than women with 20 percent of the men and 40 percent of the women in the study having a “Type-C” fracture (a fracture involving the wrist joint).
“Treating men for bone fractures, but not the underlying cause, places them at a greater risk for future bone breaks and related complications,” said lead study author Tamara Rozental, MD, associate professor of orthopaedic surgery, Harvard Medical School. “The results of this study lead us to suggest that men over the age of 50 with fractures of the distal radius should undergo bone density testing and evaluation with the FRAX algorithm to better identify those at high risk for future fracture and those who would benefit from further treatment.”
 
Study Details
Researchers reviewed the medical records of all patients with a distal radial fracture treated at a single tertiary care institution between 2007 and 2012. Data collected included age, mechanism of injury, fracture severity, associated comorbidities, and type of treatment. Fractures were classified according to the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification system. Comorbidities were estimated with use of the Charlson comorbidity index (CCI), providing a weighted score to predict short and long-term outcomes, taking into account the number and severity of predefined comorbid conditions. The WHO online Fracture Risk Assessment Tool (FRAX) was used to estimate the 10-year risk of major osteoporotic fractures in men.
 
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institutions, have had any financial relationship in the thirty-six months prior to the submission of this work, with any entity in the biomedical area that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence, what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work.
 
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