At what age should osteoporosis screening start in males?

From the Guidelines

Osteoporosis screening in males should generally begin at age 65 for those with no risk factors, as at least 6% of men have DXA-determined osteoporosis by this age. However, men with risk factors such as long-term corticosteroid use, hypogonadism, alcohol abuse, smoking, low body weight, previous fractures, or certain medical conditions (like rheumatoid arthritis or malabsorption disorders) should consider screening earlier, typically between ages 50-64 1. Screening is done via dual-energy X-ray absorptiometry (DXA) scan, which measures bone mineral density. The goal of screening is to identify bone loss early to implement preventive measures including calcium (1000-1200 mg daily) and vitamin D (600-800 IU daily) supplementation, weight-bearing exercise, smoking cessation, and limiting alcohol consumption before fractures occur. Some key points to consider when screening for osteoporosis in men include:

• Risk assessment is important, and factors that increase the risk for osteoporosis in men include age (>70 years), low body weight (body mass index <20 to 25 kg/m2), weight loss (>10% [compared with the usual young or adult weight or weight loss in recent years]), physical inactivity, corticosteroid use, androgen deprivation therapy, and previous fragility fracture 1.
• The USPSTF concludes that, for men, evidence of the benefits of screening for osteoporosis is lacking, and the balance of benefits and harms cannot be determined 1.
• Men most likely to benefit from screening have a 10-year risk of osteoporotic fracture equal to or greater than that of a 65-year-old white woman without risk factors 1. It is essential to weigh the potential benefits and harms of screening for osteoporosis in men, considering the current lack of evidence on the benefits of screening in this population 1.

From the Research

Osteoporosis Screening in Males

• Osteoporosis affects a significant portion of the adult population, with 10.2% of adults older than 50 years affected, and this number is expected to increase to 13.6% by 2030 2.
• The Bone Health and Osteoporosis Foundation recommends screening men 70 years and older and men with clinical risk factors for osteoporosis 2.
• However, the U.S. Preventive Services Task Force did not find sufficient evidence to support routine screening in men 2, 3.
• Other studies suggest that men aged 70 years and older should be screened for osteoporosis, with some recommending screening for men with at least one major or two minor risk factors for osteoporosis 4, 5.
• The optimal approach for selecting men for bone mineral density (BMD) testing to screen for osteoporosis is uncertain, but the Osteoporosis Self-Assessment Tool (OST) and Fracture Risk Assessment Tool (FRAX) without BMD can be used to discriminate between those with and without osteoporosis 6.

Screening Strategies

• The use of an OST threshold of <2 resulted in sensitivity of 0.83 and specificity of 0.36 for the identification of osteoporosis, compared to sensitivity of 0.59 and specificity of 0.59 for the use of FRAX with a cutoff of 9.3% 10-year risk of major osteoporotic fracture 6.
• Dual-energy x-ray absorptiometry (DXA) is currently one of the most widely accepted and utilized methods for assessing BMD, and it predicts fractures similarly for men and women 4, 3.
• Other potential tests for detecting osteoporosis include quantitative ultrasound, quantitative computer tomography, and biochemical markers of bone turnover 4.

Risk Factors and Prevention

• All adult patients aged ≥50 years should be evaluated for risk factors for osteoporosis, and screening with BMD testing for osteoporosis is recommended in men aged ≥70 years 4.
• Men with clinical risk factors, such as a family history of osteoporosis, should also be screened for osteoporosis 2, 5.
• Patients with osteoporosis should be counseled on weight-bearing exercise, smoking cessation, moderation of alcohol intake, and calcium and vitamin D supplementation 2.