Background/Purpose:

The National Osteoporosis Foundation (NOF) currently recommends osteoporosis screening with bone mineral density (BMD) testing in men age 70 and older, regardless of clinical risk factors. Despite these recommendations being published initially in 2008, data regarding BMD testing rates in men age 70 and older in a primary care setting in the United States are lacking. We hypothesize that BMD testing rates using Dual-energy X-ray absorptiometry (DEXA) scan in men age 70 and older remains low despite recommendations by the NOF.

Methods:

We performed a retrospective chart review of male patients age 70 and older who were seen at the Internal Medicine Clinic at Texas Tech University Health Science Center, a major primary care setting in West Texas. We reviewed charts of patients seen between January 1^st, 2011 and January 1^st, 2012. We identified patients who had established the Internal Medicine Clinic as their primary care provider. We included patients who had been seen at least twice over a 3 year period. We excluded patients who were one time hospital discharge follow-ups and those who visited the internal medicine clinic for preoperative evaluations. Demographic information and BMD testing status were determined from electronic medical records. 10-year osteoporotic and hip fracture probabilities of individual patients were calculated using the World Health Organization Fracture Risk Assessment Tool. Analysis of the effect of increasing age on BMD testing was performed using chi square test for trend with patients divided into age groups of 70-74, 75-79, 80-84, 85-89, 90-94 and 95-99. The Pearson’s correlation was used to analyze correlation of age with 10-year osteoporotic and hip fracture probabilities. 

Results:

The median age of our patients was 76 years (range 70-98 years). There were 341 male patients age 70 and older who were seen at the clinic during the study period. 310 patients were included in the study. 35 patients, which is 11.4% (95%CI [7.9-15.7]) of the study population received BMD testing using DEXA scans. BMD testing indicated that 8 patients (22.9%) were osteoporotic, 22 patients (62.9%) were osteopenic, and 5 patients (14.3%) had normal BMD. No significant association was found between increasing age and BMD testing (p=0.299). The medians of the 10-year osteoporotic and hip fracture probabilities in the 70-74 age group were 5.6% (range 2.0-14.0%) and 1.4% (range 0.2-5.3%). The medians of the 10-year osteoporotic and hip fracture probabilities peaked in the 90-94 age group at 9.4% (range 5.7-10.0%) and 6.1% (range 3.0-7.9%) respectively. Age was positively correlated with 10-year hip fracture probability (r=0.68, p<0.0001) and 10-year osteoporotic fracture probability (r= 0.53, p<0.0001).

Conclusion:

Osteoporosis in men age 70 and older is still underscreened and underrecognized. Despite recommendations by the NOF for BMD testing using DEXA scan in men age 70 and older since 2008, BMD testing rates remain low. Although there was an increase in both the 10-year osteoporotic and hip fracture probabilities with age, no association was found between increased age and BMD testing. In view of the aging society in the United States, more has to be done to increase awareness of this major public health problem.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/screening-of-osteoporosis-in-men-age-70-and-older-a-need-for-increased-awareness/