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Men's Health: Men can benefit from testing and treatment for brittle bones

Canadian expert says recent warning about the costs of male osteoporosis screening was unfounded

p>American researchers recently concluded that screening older men for osteoporosis, or brittle bones, and putting them on bone-strengthening medication may not be cost-effective, but a Canadian expert says the main problem is that not enough men are getting their bone health checked in the first place.

The U.S. study, headed by Dr. John Schousboe of Park Nicollet Health Services in Minneapolis, examined the cost-effectiveness of screening all men age 65 years and older for osteoporosis, and putting those found to have the condition on bone-strengthening drugs called bisphosphonates for five years. The researchers concluded this strategy was cost-effective only if the men had already broken a bone, or were 80 to 85 years old.

However, Dr. Aliya Khan, a professor of clinical medicine at McMaster University in Hamilton and a member of Osteoporosis Canada’s scientific advisory council, says the U.S. study oversimplifies the diagnosis of osteoporosis by focusing only on low bone density and previous fractures as indicators of risk. In some cases, the condition can be caused by abnormal hormone levels or by long-term use of medications such as corticosteroid pills.

“We’re recommending doing some basic investigation, starting people on calcium and vitamin D, and then, depending on where their fracture risk is, deciding whether they need to go on actual drug therapy,” Khan says.

“Right now we feel there’s still underdiagnosis and undertreatment of osteoporosis in the male population,” she adds. “Just from the patients I get referred, many of the male patients are diagnosed after they’ve had a number of fragility fractures. These could be important fractures like hip fractures, and the men could have been admitted to hospital, but the osteoporosis was not diagnosed or treated.”

According to Osteoporosis Canada, one in four women and one in eight men over the age of 50 has osteoporosis. Elderly men account for almost 30 per cent of hip fracture cases, and men are more likely to die after a hip fracture than women.

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