What are the osteoporosis screening guidelines for men over 65 years old?

Osteoporosis Screening Guidelines for Men Over 65 Years Old

Currently, there is insufficient evidence to recommend routine osteoporosis screening for all men over 65 years old, but screening should be performed in men with risk factors for osteoporosis or fractures. 1

Current Recommendations by Major Organizations

• U.S. Preventive Services Task Force (USPSTF): Provides an "I" statement (insufficient evidence) for routine screening in men without previous fractures or secondary causes of osteoporosis 1
• American College of Physicians (ACP): Recommends periodic individualized risk assessment for men, with DXA testing for those at increased risk 1
• Bone Health and Osteoporosis Foundation: Recommends screening men 70 years and older and men with clinical risk factors 2

Risk Assessment for Men

High-Risk Factors That Warrant Screening

• Age >70 years 1
• Low body weight (BMI <20-25 kg/m²) 1
• Weight loss >10% compared to usual adult weight 1
• Physical inactivity 1
• Previous fragility fracture 1, 3
• Systemic corticosteroid therapy 1
• Androgen deprivation therapy 1
• Spinal cord injury 1
• Parental history of hip fracture 4
• Cigarette smoking 1, 4
• Excessive alcohol consumption 4, 5
• Secondary causes of osteoporosis:
  • Hypogonadism 5
  • Gastrointestinal diseases with malabsorption 5
  • Hypercalciuria and nephrolithiasis 5
  • Anticonvulsant use 5
  • Thyrotoxicosis 5
  • Chronic liver or kidney disease 4

Screening Method

• Dual-energy X-ray absorptiometry (DXA) of the hip and lumbar spine is the accepted reference standard for diagnosing osteoporosis in men 1
• Calcaneal ultrasonography predicts fracture risk but is not recommended as a substitute for DXA for diagnosis 1

Clinical Approach to Osteoporosis Screening in Men >65

1. Perform individualized risk assessment for all men over 65 years 1
2. Obtain DXA for men with one or more high-risk factors listed above 1
3. Consider fracture risk assessment tools like FRAX to estimate 10-year absolute fracture risk 6
4. Prioritize screening for men with fragility fractures, as these are diagnostic for osteoporosis regardless of BMD results 3

Important Clinical Considerations

• Prevalence of osteoporosis in men aged 65 years or older is approximately 5.7% 1
• Men have similar risk factors for fragility fractures as women, but the prevalence is lower 1
• Excess mortality related to osteoporotic fractures is greater in men than in women 1
• One-third of men who experience a hip fracture die within 1 year 1
• Men most likely to benefit from screening have a 10-year fracture risk equal to or greater than that of a 65-year-old white woman without risk factors (approximately 9.3%) 1

Common Pitfalls to Avoid

• Failing to recognize fragility fractures as diagnostic for osteoporosis requiring immediate intervention 3
• Overlooking secondary causes of osteoporosis, which are present in 30-60% of men with vertebral fractures 5
• Not considering age-related decline in testosterone and its impact on bone health 5
• Assuming cardiovascular disease alone is a strong indication for screening 3

By following these guidelines, clinicians can identify men at high risk for osteoporosis and fractures, potentially reducing the associated morbidity, mortality, and decreased quality of life.