Men's Osteoporosis Support Group
Bisphosphonate therapy in older men after fractures
Osteoporos Int. 2011 Aug 3. [Epub ahead of print]. Treatment for older men with fractures. Shepherd AJ and others. PMID: 21811867. This study involved the insurance records of 17,683 men at least 65 years of age or older who had a fracture between 2000 and 2005. The men were followed for six months to see if bisphosphonate therapy was started. Various characteristics were compared between men who started therapy and those who didn't.
Results showed that 8% of the men started bisphosphonate therapy and treatment increased from 7% to 9% from 2001 to 2005. Treatment also increased with age: 6% in men aged 65-69 vs. 11.6% in men aged 85-89. Many other factors were associated with treatment: diagnosis of osteoporosis, glucocorticoid therapy, bone mineral density measured, antidepressant medications, vertebral fractures, and men seen by primary physicians.
The authors concluded, “Less than 10% of men received bisphosphonate therapy following a low-impact fracture. Men with a primary physician were more likely to receive bisphosphonate therapy; however, <25% of men were seen by a primary physician.”
Editor's comments. I don't have access to the full article, so some of my concerns might have been addressed in it. My presumption is that anyone with a low-impact fracture has osteoporosis until proven otherwise. However, maximum treatment only reached 9% in this study, why? I have never seen a study that uncovered all the reasons for not diagnosing and treating men (or women) who have had low-trauma fractures. I hope someone will do one because it will be enlightening and helpful. Here are some of the possible reasons:
1. Orthopedic surgeons direct their attention to repairing the fracture and don't concern themselves with finding its cause. That would include referring the fracture patient to another care provider for an osteoporosis diagnostic workup virtually 100% of the time as part of their normal routine after low-trauma fracture.
2. People who have had low-trauma fracture don't follow up when a recommendation or referral is made to a care provider who could provide osteoporosis diagnostic procedures.
3. Men (or women) taking high-dose, long-term glucocorticoids (prednisone, etc.) should have been referred for an osteoporosis work up when that therapy was initiated—not after a fracture. If they don't have osteoporosis, they should at least be started on preventive medications. See the American College of Rheumatology Practice Guidelines on this topic.
4. Anti-depressant medications are a known risk factor for osteoporosis so individuals taking them should be evaluated for osteoporosis and likely be using preventive measures or taking FDA-approved osteoporosis medications. Last week's Update cited a recent article on this topic and referred to other Updates for more information.
Bottom line: A low-trauma fracture must be assumed to be the result of osteoporosis until proven otherwise. It behooves anyone who has such a fracture to demand a referral to a care provider who can have diagnostic testing done to determine bone mineral density and other factors that might be causative of osteoporosis. Also, if you know anyone who has a low-trauma fracture, explain to them the importance of an osteoporosis diagnostic workup to prevent a possible additional fracture and the related morbidity that involves.