Normal Bone Density in Men Does Not Prevent Fractures—Fall Prevention Still Needed

Margaret L. Gourlay, MD, MPH Assistant Professor UNC Department of Family Medicine Chapel Hill, NC 27599-7595

Dr. Margaret Gourlay

MedicalResearch.com Interview with:
Margaret L. Gourlay, MD, MPH
Assistant Professor
UNC Department of Family Medicine
Chapel Hill, NC 27599-7595

Medical Research: What is the background for this study? What are the main findings?

Dr. Gourlay: While clinical practice guidelines universally recommend bone density screening for fracture prevention in women aged 65 years and older, minimal data exist to guide bone density screening in older men. We studied how often bone density screening tests should be ordered in men, using data from the Osteoporotic Fractures in Men (MrOS) Study. MrOS is the largest and longest-running (since 2000) US study of bone density and fracture in men aged 65 and older.

After peak bone mass is reached in young adulthood, both men and women lose bone density as they get older. Based on our earlier findings in older women, we expected that men aged 65 and older with higher bone density T-score measurements (T-score >-1.50) on a first (baseline) bone density test would have a substantially longer estimated time to develop the lowest level of bone density (osteoporosis) than men with better baseline measurements. Clinicians want to know the time to osteoporosis because they prescribe osteoporosis treatments to prevent future fractures in elderly patients.

As expected, we found that the men with higher baseline bone density had a much slower transition to osteoporosis compared to men with lower bone density. In fact, only nine out of 4203 (0.2%) of men with higher baseline bone density developed osteoporosis after an average of 8.7 years of bone density follow-up. That was much lower than we expected and is good news for men who have favorable scores on their first bone density test. Men who had lower baseline bone density measurements developed osteoporosis faster.

Unfortunately, maintaining bone density above the osteoporosis range did not guarantee that men remained fracture-free.   Most of the major osteoporotic fractures (broken hip, spine, wrist or upper arm/shoulder) occurred in men who did not have osteoporosis. This might be because they had accidents or injuries that broke their bones despite their bone density being above the thinnest range.

Medical Research: What should clinicians and patients take away from your report?

Dr. Gourlay: The most important take-away point from our study is that bone density testing can give us useful information about when an older man might need medication for fracture prevention. I think bone density testing should be used more often in men aged 65 and older, but current Medicare guidelines make that difficult because reimbursement criteria are much stricter for men than for women.

The second take-away point is that a favorable baseline bone density test does not guarantee that a man will never have a fracture. Doctors and older men themselves need to be very careful about preventing falls, because falls are the most common reason that older individuals have the most serious types of fractures (hip and spine fractures). Many older men who have hip and spine fractures never walk normally again or have persistent pain for many years. Thus, we would much rather prevent fractures from occurring than deal with the serious lifelong consequences of fractures after it is too late.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Gourlay: The next important study on this topic will estimate the best age to start bone density testing in older men. Our current study does not directly address that, but one of our authors (Carrie Nielson PhD, MPH) is already working on a study of the starting age for testing. 

Medical Research: Is there anything else you would like to add?

Dr. Gourlay: Thank you for asking about this underappreciated healthcare problem. Now that more data are available on men, we hope to have more studies and clearer clinical practice guidelines for bone density screening in men within the next 10 years.

Citation:

Time to Osteoporosis and Major Fracture in Older Men
Gourlay, Margaret L. et al.
American Journal of Preventive Medicine , Volume 0 , Issue 0 ,
DOI: http://dx.doi.org/10.1016/j.amepre.2015.11.015

Published Online: January 24, 2016

Dr. Margaret Gourlay (2016). Normal Bone Density in Men Does Not Prevent Fractures—Fall Prevention Still Needed 

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