Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, School of Medicine, Seattle, Washington, USA.
Division of Endocrinology, Metabolism and Nutrition, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.
J Investig Med. 2019 Apr;67(4):743-749. doi: 10.1136/jim-2018-000907. Epub 2019 Feb 5.
We compared osteoporosis case-finding, evaluation and treatment in groups of Older Men and Older Women with age alone as a significant risk for fracture and Older Men with Higher Risk (older men additionally having previous hip fracture, corticosteroid use or androgen deprivation therapy). We studied 13,704 older men and women (≥70 years old) receiving care at a Veterans Affairs medical center from January 2000 to August 2010 whose 10-year hip fracture risk was assessed by limited FRAX score. The main outcome measures were the proportion of patients who had bone mineral density (by dual-energy X-ray absorptiometry [DXA]) and serum 25-hydroxy vitamin D (25-OH D) measurements performed, and calcium/vitamin D or bisphosphonates prescribed. The proportion of men with a 10-year hip fracture risk ≥3% with age alone as a risk was 48% and 88% in men aged 75-79 and ≥80 years, respectively. Compared with Older Women, fewer Older Men underwent DXA (12% vs 63%, respectively) and 25-OH D measurements (18% vs 39%), and fewer received calcium/vitamin D (20% vs 63%) and bisphosphonate (5% vs 44%) prescriptions. In Older Men with Higher Risk category, the proportion of men with 10-year hip fracture risk ≥3% ranged from 69% to 95%. Despite a higher risk and expectation that this group would have greater case detection and screening, few Older Men with Higher risk underwent DXA screening (27%-36%) and 25-OH D measurements (23%-28%), and received fewer calcium/vitamin D (40%-50%) and bisphosphonate (13%-24%) prescriptions. Considering the known morbidity and mortality, our findings underscore the need for improved evaluation and management of osteoporosis in older men at high risk for fracture.
我们比较了年龄是导致骨折的重要风险因素的老年男性和老年女性（骨质疏松症病例发现、评估和治疗组），以及年龄较大且具有更高风险的男性（这些男性还患有先前的髋部骨折、皮质类固醇使用或雄激素剥夺治疗）。我们研究了 13704 名年龄在 70 岁以上的老年男性和女性（≥70 岁），他们在退伍军人事务医疗中心接受治疗，从 2000 年 1 月至 2010 年 8 月，他们的 10 年髋部骨折风险通过有限的 FRAX 评分评估。主要观察指标为接受骨密度（双能 X 射线吸收法 [DXA]）和血清 25-羟基维生素 D（25-OH D）测量以及钙/维生素 D 或双膦酸盐治疗的患者比例。年龄是导致骨折的重要风险因素的男性中，10 年髋部骨折风险≥3%的比例分别为 48%和 75-79 岁和≥80 岁的男性的 88%。与老年女性相比，较少的老年男性接受 DXA（分别为 12%和 63%）和 25-OH D 测量（分别为 18%和 39%），并且较少的人接受钙/维生素 D（分别为 20%和 63%）和双膦酸盐（分别为 5%和 44%）处方。在高风险类别中，10 年髋部骨折风险≥3%的男性比例从 69%到 95%不等。尽管存在更高的风险，并且预期该组会有更大的病例发现和筛查，但很少有高风险的老年男性接受 DXA 筛查（27%-36%）和 25-OH D 测量（23%-28%），并且接受的钙/维生素 D（40%-50%）和双膦酸盐（13%-24%）处方较少。考虑到已知的发病率和死亡率，我们的研究结果强调了需要改善高骨折风险老年男性的骨质疏松症评估和管理。
