OSTEOPOROSIS-OVERLOOKED IN MEN FOR TOO LONG

[gmohan]

Osteoporosis: overlooked in men for too long

The Lancet Diabetes & Endocrinology
Published:December 04, 2020DOI:https://doi.org/10.1016/S2213-8587(20)30408-3

A commonly held public misconception about osteoporosis is that it affects only women, as a consequence of declining oestrogen levels from menopause onwards. Yet, of the 8·9 million fractures caused by osteoporosis globally each year, 20–25% occur in men. With the prevalence of osteoporotic fractures predicted to increase in coming decades due to population ageing, together with some major fractures (eg, hip) forecast to rise more in men than in women, male osteoporosis is a growing but under-recognised public health concern.

Highlighting the need for urgent action, findings presented at the recent American College of Rheumatology Convergence 2020 (Nov 5–9) reveal that older men (aged 65 years or older) who experience a fracture are underdiagnosed with and undertreated for osteoporosis.
The study analysed 9876 male US Medicare beneficiaries who had an osteoporotic fracture (most commonly spine [31·0%], hip [27·9%], or ankle [9·8%]). Worryingly, only 2·1% were diagnosed with osteoporosis and treated accordingly; 2·8% were diagnosed but not treated, and 2·3% were treated but not diagnosed.
Moreover, in the 2 years preceding their fracture, less than 6% of men had their bone mineral density measured, underscoring the lack of consistent guidelines for screening in men.

Tackling underdiagnosis and undertreatment of osteoporosis in men will not solve the ongoing crisis in osteoporosis, which has seen declining use of osteoporosis drugs across the board due to fear of rare adverse events. It is, however, part of the wider problem and a glaring disparity that must be addressed.

Raising awareness among men about osteoporosis, particularly the initially silent nature of the disease; improving communication between the many specialties involved in the care of these patients and their recognition of falls and fractures as signs of osteoporosis; and, above all else, implementing routine screening for men of a certain age and those with risk factors for the disease are crucial if we are to improve the outcomes of men with osteoporosis and reduce gender disparity in osteoporosis care.