Osteoporosis screening recommended for men at risk

By Laura Cowen

Men at increased risk for osteoporosis should undergo bone mineral density (BMD) testing with dual energy X-ray absorptiometry (DXA), concludes The Endocrine Society's Clinical Practice Guideline "Osteoporosis in Men."

The guideline, published in the Journal of Clinical Endocrinology and Metabolism, recommends that men aged 70 years and older, and those aged 50-69 years with additional risk factors such as low body weight, prior fracture as an adult, smoking, or conditions such as hypogonadism and hyperthyroidism, should undergo testing for osteoporosis.

"For men age 50, one in five will experience an osteoporosis-related fracture in their lifetime," said Task Force chair Nelson Watts (Mercy Health Osteoporosis and Bone Health Services, Cincinnati, Ohio, USA) in a press statement.

"Mortality after fracture is higher in men than in women. Of the 10 million Americans with osteoporosis, 2 million are men. Of the 2 million fractures due to osteoporosis that occur each year, 600,000 are in men."

With this data in mind, the Clinical Guidelines Subcommittee of The Endocrine Society deemed osteoporosis in men a priority and thus appointed a Task Force to formulate evidence-based recommendations.

In addition to DXA testing for men with increased osteoporosis risk, the guideline recommends laboratory testing to detect contributing causes.

Men with low vitamin D levels (<30 ng/mL) should receive vitamin D supplementation to achieve levels of at least 30 ng/mL, while all men at risk for osteoporosis should be encouraged to consume 1000-1200 mg of calcium daily, ideally from dietary sources, with calcium supplements added if dietary calcium is insufficient.

Weight-bearing exercise is also recommended, whereas smoking and excessive alcohol should be avoided, the guideline states.

In addition, pharmacologic treatment is recommended for men aged 50 years or older who have had spine or hip fractures, and men at high risk of fracture based on low bone mineral density (T-scores of −2.5 or below) and/or clinical risk factors.

Finally the Task Force suggests that clinicians should monitor BMD by DXA at the spine and hip every 1 to 2 years to assess the response to treatment. If BMD reaches a plateau, the frequency of BMD measurements may be reduced, the authors add.

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