Undertreatment of Osteoporosis in Men With Hip Fracture

Kiebzak, Gary M.; Beinart, Garth; Perser, Karen; Ambrose, Catherine G.; Siff, Sherwin J.; Heggeness, Michael H.

doi:10.1001/archinte.162.19.2217

Cited by 337 publications

(222 citation statements)

References 31 publications

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“…(21) For example, men who have sustained an obvious fragility fracture (and who have osteoporosis on clinical grounds) are rarely evaluated for osteoporosis, and this cannot be corrected simply by using a different reference population. (21,22) When FRAX or other absolute fracture assessment systems are used in men, it is essential to clearly indicate the BMD normalization procedure to be used. To avoid confusion, the latest Web-based version of the FRAX tool now allows for absolute BMD to be entered directly (with equipment manufacture designation).…”

Section: Discussionmentioning

confidence: 99%

Using the same bone density reference database for men and women provides a simpler estimation of fracture risk

Langsetmo

Leslie

Zhou

et al. 2010

Journal of Bone and Mineral Research

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Although low bone mineral density (BMD) predicts fractures, there are postulated sex differences in the fracture ''threshold.'' Some studies demonstrate a higher mean BMD for men with fractures than for women, whereas others note similar absolute risk at the same level of BMD. Our objective was to test the preceding observations in the population-based Canadian Multicentre Osteoporosis Study (CaMOS). We included participants 50þ years of age at baseline. Mean BMD in men was higher than in women among both fracture cases and noncases. Three methods of BMD normalization were compared in age-adjusted Cox proportional hazards models. In a model using the same reference population mean and standard deviation (SD), there were strong effects of age and total-hip BMD for prediction of fractures but no significant effect of sex [hazard ratio (HR) ¼ 0.97, 95% confidence interval (CI) 0.78-1.20] for men versus women. In a model using sex-specific reference means but a common SD, an apparent sex difference emerged (HR ¼ 0.66, 95% CI 0.54-0.81) for men versus women. The sex term in the second model counterbalanced the higher risk introduced by the lower normalized BMD in men. A third model using sex-specific reference means and SDs gave nearly identical results. Parallel results for the three methods of normalization were seen when adjusting for clinical risk factors, excluding antiresorptive users and considering death as a competing risk. We conclude that no adjustment for sex is necessary when using common reference data for both men and women, whereas using sex-specific reference data requires a substantial secondary adjustment for sex. ß

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Section: Discussionmentioning

confidence: 99%

Using the same bone density reference database for men and women provides a simpler estimation of fracture risk

Langsetmo

Leslie

Zhou

et al. 2010

Journal of Bone and Mineral Research

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“…Men were about 75% less likely to receive osteoporosis treatment during the hospital stay than women; only 2.2% of men received any osteoporosis treatment, compared to 8.9% of women. In another study of treatment in a Texas hospital, only 27% of men with hip fracture reported receiving treatment 1 year after the fracture, compared with more than two-thirds (71%) of women reporting treatment [19]. Of the men who received treatment, twothirds received calcium and vitamin D (compared to 32% of the treated women), rather than an antiresorptive or bone-forming agent.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…Additionally, a lower proportion of men at high risk of fracture are treated than women at high risk [19]. Men also tend to have worse outcomes after fracture than women; they are twice as likely to die after hip fracture than women [13].…”

Section: Introductionmentioning

confidence: 99%

Gender Differences in Osteoporosis and Fractures

Cawthon

2011

Clinical Orthopaedics &Amp; Related Research

245

153

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Background Osteoporosis is generally thought of as a ''woman's disease'' because the prevalence of osteoporosis and the rate of fractures are much higher in postmenopausal women than in older men. However, the absolute number of men affected by osteoporosis and fractures is large, as at least 2.8 million men in the United States are thought to have osteoporosis. Questions/purposes The purposes of this review are to (1) highlight gender differences in osteoporosis and fracture risk, (2) describe disparities in treatment and outcomes after fractures between men and women, and (3) propose solutions to reducing disparities in treatment and prevention. Methods A literature survey was conducted using MEDLINE with a variety of search terms and using references from the author's personal collection of articles. A formal search strategy and exclusion criteria were not employed and the review is therefore selective. Where are we now? Postmenopausal women have a higher prevalence of osteoporosis and greater incidence of fracture than older men. Despite the higher fracture risk in postmenopausal women, older men tend to have worse outcomes after fracture and poorer treatment rates, although less is known about the disease course in men.Multifaceted interventions to improve the screening and treatment for osteoporosis were recently developed. Where do we need to go? Improvement in treatment rates of those at risk, regardless of gender, is an important goal in osteoporosis management. How do we get there? Further development and evaluation of cost-effective, multifaceted interventions for screening and treatment of osteoporosis and fractures are needed; such interventions will likely improve the primary prevention of fractures.

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“…Despite its prevalence across both sexes, osteoporosis does not affect men and women equally [19,30,34]; there are important sex-and gender-based distinctions between men and women that should be acknowledged. The Institute of Medicine recognized the importance of using the term ''sex'' to refer to factors that are primarily biologic in origin and ''gender'' to refer to social and cultural influences based on sex [18].…”

Section: Introductionmentioning

confidence: 99%

“…This distinction is important to understand, as both sex-and gender-based characteristics influence the pathophysiology, diagnosis, prognosis, and treatment of osteoporosis and its sequelae. These sex and gender differences ultimately influence the rates of morbidity and mortality in men who sustain a hip fracture [8,27,30], as men are more likely than women to have osteoporosis that is undiagnosed or undertreated [19,30,34].…”

Section: Introductionmentioning

confidence: 99%

Sex and Gender Considerations in Male Patients With Osteoporosis

LaMont

Ton

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Osteoporosis remains underrecognized and undertreated in both men and women, but men who sustain fragility fractures experience greater morbidity and mortality. While men exhibit advanced comorbidity at the time of hip fracture presentation, there are distinct sex-and gender-specific factors related to the pathophysiology and treatment of osteoporosis that further influence morbidity and mortality. Questions/purposes With a selective review of the literature, we evaluated sex-and gender-based differences contributing to increased morbidity and mortality in men with osteoporosis.

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Undertreatment of Osteoporosis in Men With Hip Fracture

Abstract: The burden of hip fracture is illustrated by the high incidence of postfracture disability and the high mortality rate in both men and women. Nevertheless, few men receive antiresorptive treatment.

Cited by 337 publications

References 31 publications

Using the same bone density reference database for men and women provides a simpler estimation of fracture risk

Using the same bone density reference database for men and women provides a simpler estimation of fracture risk

Gender Differences in Osteoporosis and Fractures

Sex and Gender Considerations in Male Patients With Osteoporosis

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