Osteoporosis, which means very low bone density, is a major risk factor for fractures.  Fractures can be catastrophic for older people, and effective medicines exist to treat osteoporosis and prevent fractures, so detecting osteoporosis before a fracture happens is very important in older patients.  Since osteoporosis is very common in postmenopausal women, screening them for osteoporosis is a well-established part of preventive care.

Though men are less likely then women to have osteoporosis, a fracture in an older man is just as potentially catastrophic.  Until now, no clear guidelines have been available to guide physicians about whether or when to screen men for osteoporosis.  Frequently, therefore, osteoporosis has been diagnosed in men after the first fracture.

This week, the Annals of Internal Medicine published a review of the medical literature about screening men for osteoporosis, and on the basis of this review, the American College of Physicians issued a clinical practice guideline for screening men for osteoporosis.  Their recommendations are:

  • Clinicians should periodically perform individualized assessment of risk factors for osteoporosis in older men.
    Risk factors for osteoporosis are

    • age (>70 years)
    • low body weight (body mass index <20 to 25)
    • weight loss
    • physical inactivity
    • corticosteroid use
    • androgen deprivation therapy
    • previous fragility fracture
  • Clinicians should obtain dual-energy x-ray absorptiometry (DEXA bone density scans) for men who are at increased risk for osteoporosis and are candidates for drug therapy.

Though much is still not clarified, like the number of risk factors that should prompt screening or the frequency with which screening should occur, this is a valuable start.  So if you’re an older skinny sedentary guy (or if you love one) ask your doctor about getting a test for osteoporosis.

Learn more:

The American College of Physicians clinical practice guideline:  Screening for Osteoporosis in Men