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Osteoporosis screening for men

Are family physicians following the guidelines?

Michael E. Green, MD MPH CCFP
Assistant Professor in the departments of family medicine and community health and epidemiology at Queen’s University and is a member of the Centre for Health Services and Policy Research and the Centre for Studies in Primary Care

Correspondence to: Dr Michael Green, Department of Family Medicine, CHSPR, Abramsky Hall, 3rd Floor, Queen’s University, 21 Arch St, Kingston, ON K7L 3N6; telephone 613 533-6387; fax 613 533-6353; e-mailmg13{at}queensu.ca

OBJECTIVE To determine rates of screening for osteoporosis among men older than 65 years and to find out whether family physicians are following the recommendations of the Osteoporosis Society of Canada’s 2002 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada.

DESIGN Chart audit.

SETTING The Family Medicine Centre at Hotel Dieu Hospital in Kingston, Ont.

PARTICIPANTS All male patients at the Family Medicine Centre older than 65 years for a total of 565 patients associated with 20 different physicians’ practices.

MAIN OUTCOME MEASURES Rates of screening with bone mineral density (BMD) scans for osteoporosis, results of BMD testing, and associations between results of BMD testing and age.

RESULTS Of the 565 patients reviewed, 108 (19.1% of the study population) had received BMD testing. Rates of screening ranged from 0% to 38% in the 20 practices. Among 105 patients tested (reports for 3 patients were not retrievable), 15 (14.3%) were found to have osteoporosis, 43 (41.0%) to have osteopenia, and 47 (44.8%) to have normal BMD results. No significant association was found between BMD results and age. Screening rates were higher among men older than 75 years than among men aged 65 to 75 and peaked among those 85 to 89 years old.

CONCLUSION On average, only about 20% of male patients older than 65 years had been screened for osteoporosis, so most of these men were not being screened by BMD testing as recommended in the guidelines. Considering the relatively high rates of osteoporosis and osteopenia found in this study and the known morbidity and mortality associated with osteoporotic fractures in this population, higher rates of BMD screening and more widespread treatment of osteoporosis could prevent many fractures among these patients. Family physicians need to become more aware of the risk factors indicating screening, and barriers to screening and treatment of osteoporosis in men need to be identified and addressed.

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