PT  - JOURNAL ARTICLE
AU  - Radhika Rao Narla
AU  - Lianne A Hirano
AU  - Serena H Y Lo
AU  - Bradley D Anawalt
AU  - Elizabeth A Phelan
AU  - Alvin M Matsumoto
TI  - Suboptimal osteoporosis evaluation and treatment in older men with and without additional high-risk factors for fractures
AID  - 10.1136/jim-2018-000907
DP  - 2019 Feb 12
TA  - Journal of Investigative Medicine
PG  - jim-2018-000907
4099  - http://hw-f5-jim.highwire.org/content/early/2019/02/11/jim-2018-000907.short
4100  - http://hw-f5-jim.highwire.org/content/early/2019/02/11/jim-2018-000907.full
AB  - We compared osteoporosis case-finding, evaluation and treatment in groups of Older Men and Older Women with age alone as a significant risk for fracture and Older Men with Higher Risk (older men additionally having previous hip fracture, corticosteroid use or androgen deprivation therapy). We studied 13,704 older men and women (≥70 years old) receiving care at a Veterans Affairs medical center from January 2000 to August 2010 whose 10-year hip fracture risk was assessed by limited FRAX score. The main outcome measures were the proportion of patients who had bone mineral density (by dual-energy X-ray absorptiometry [DXA]) and serum 25-hydroxy vitamin D (25-OH D) measurements performed, and calcium/vitamin D or bisphosphonates prescribed. The proportion of men with a 10-year hip fracture risk ≥3% with age alone as a risk was 48% and 88% in men aged 75–79 and ≥80 years, respectively. Compared with Older Women, fewer Older Men underwent DXA (12% vs 63%, respectively) and 25-OH D measurements (18% vs 39%), and fewer received calcium/vitamin D (20% vs 63%) and bisphosphonate (5% vs 44%) prescriptions. In Older Men with Higher Risk category, the proportion of men with 10-year hip fracture risk ≥3% ranged from 69% to 95%. Despite a higher risk and expectation that this group would have greater case detection and screening, few Older Men with Higher risk underwent DXA screening (27%–36%) and 25-OH D measurements (23%–28%), and received fewer calcium/vitamin D (40%–50%) and bisphosphonate (13%–24%) prescriptions. Considering the known morbidity and mortality, our findings underscore the need for improved evaluation and management of osteoporosis in older men at high risk for fracture.