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Suboptimal osteoporosis evaluation and treatment in older men with and without additional high-risk factors for fractures
  1. Radhika Rao Narla1,2,
  2. Lianne A Hirano3,4,
  3. Serena H Y Lo3,
  4. Bradley D Anawalt5,
  5. Elizabeth A Phelan3,6,
  6. Alvin M Matsumoto3,4
  1. 1 Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, School of Medicine, Seattle, Washington, USA
  2. 2 Division of Endocrinology, Metabolism and Nutrition, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
  3. 3 Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
  4. 4 Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
  5. 5 Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
  6. 6 Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Radhika Rao Narla, Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, School of Medicine, Seattle, WA 98104, USA; rnarla{at}uw.edu

Abstract

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.

  • osteoporosis
  • fracture risk
  • FRAX
  • bone densitometry
  • delivery of health care
  • quality of health care

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Footnotes

  • Contributors RRN: preparation of manuscript. LAH: creating initial study concept and design. SHYL: creating initial study concept and design. BDA: creating initial study concept and design, review of manuscript. EAP: review of manuscript. AMM: creating initial study concept and design, review of manuscript.

  • Funding This project was supported by the Geriatric Research, Education and Clinical Center, Veterans Integrated Service Network 20, Department of Veterans Affairs, and funding from the VA Special Fellowship Program in Advanced Geriatrics (SHYL and LAH).

  • Competing interests None declared.

  • Ethics approval The VA Puget Sound Health Care System institutional review board approved the study protocol.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it was published Online First. In the Discussion, the sentence ’For example, women ≥70 years old with age alone as a risk factor were more than five times as likely to have a DXA and more than three times as likely to have serum 25-OH vitamin D measurement as men ≥70 years old with age alone as a risk factor for fracture (DXA: 63% vs 12% and and 25-OH vitamin D: 39% vs 12%)' has been amended to read: ’For example, women 70 years and older with age alone as a risk factor were more than five times as likely to have a DXA and around twice as likely to have serum-25-OH vitamin D measurement as men 70 years and older with age alone as a risk factor for fracture (DXA: 63% vs 12% and 25-OH: vitamin D 39% vs 18%)'.

  • Patient consent for publication Not required.

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