As the United States population continues to live longer, the incidence of osteoporotic fragility fractures is expected to increase substantially in both men and women over the next 30 years. Osteoporosis is primarily thought of as a disease that affects older women, but estimates show that more than 2 million men also have the condition. Current estimates show that as many as 25% of men older than age 50 will suffer a fracture due to osteoporosis. Wrist fractures currently rank as the third most common fragility fracture and the leading upper extremity fracture in older adults, but data are lacking on the characteristics of men who sustain these fractures.
In a study published in the Journal of Bone & Joint Surgery, Tamara D. Rozental, MD, and colleagues compared fracture characteristics, treatment, and osteoporosis evaluations among men and women who had sustained a distal radial fracture. The research team retrospectively reviewed medical records of 95 men and 344 women aged 50 and older and were treated for a wrist fracture between 2007 and 2012. According to the results, fewer men than women underwent bone mass density (BMD) testing before they sustained their fracture.
Overall, men were 10 times less likely to be screened for osteoporosis and almost 16 times less likely to be treated than women, according to Dr. Rozental. Men were also less likely to be started on treatment with calcium and vitamin D supplements within 6 months of their injury. In addition, 3% of men started taking bisphosphonates to increase bone mass, compared with a 22% rate that was seen in women.
The study used the World Health Organization’s Fracture Risk Assessment Tool (FRAX) to estimate the 10-year risk of major osteoporotic fractures in men. Using the FRAX algorithm, the study team found that 50% of men who obtained a BMD test were deemed at risk for a second major osteoporotic fracture in the next decade. “Our findings illustrate the importance of being more vigilant about screening men for osteoporosis,” says Dr. Rozental.
A BMD is considered the standard care for women older than 65 and for those older than 60 who have suffered a fragility fracture or have osteoporosis risk factors. Similar recommendations have been proposed for men, but Dr. Rozental says the rate of evaluation for osteoporosis in men is low. “Our study suggests that men older than 50 with wrist fractures should undergo evaluation with the FRAX algorithm and potentially undergo BMD testing,” she says. “This will enable us to better identify men who are at high risk for future fractures and those who may benefit from further treatment.”