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Pattern of use of DXA scans in men: a cross-sectional, population-based study

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Abstract

Summary

Osteoporosis in men is underdiagnosed. The use of dual-emission X-ray absorptiometry (DXA) was evaluated in almost 5,000 men aged 60–74 years. DXA was infrequent, despite the presence of multiple risk factors for osteoporosis and a high FRAX score. There is a need for improved targeting of DXA scans for men at high risk.

Introduction

Clinical and socioeconomic factors associated with bone mass assessment (DXA) in men have seldom been evaluated. This study aimed to evaluate factors associated with the use of DXA in men.

Methods

Self-report information on prior DXA and osteoporosis risk factors were obtained from the baseline data of a study investigating the health perspectives of men aged 60–75 years. Socioeconomic and comorbidity data were retrieved from national registers. The FRAX algorithm was used to calculate the absolute fracture risk. Regression analysis was used to identify factors significantly associated with previous DXA scan.

Results

Of the 4,696 men returning questionnaires (50% response rate), 2.7% had prior DXA but 48% had at least one osteoporosis risk factor. Previous DXA was associated with oral glucocorticoid treatment, secondary osteoporosis, rheumatoid arthritis, fracture after age 50, falls within the previous year, smoking, and higher age. Twenty-one percent of men with prior DXA and 10% of men without prior DXA had greater than 20% risk of a major osteoporotic fracture within the next 10 years. One third of those with previous DXA had none of the FRAX osteoporosis risk factors. When family history of osteoporosis and falls were included as risk factors, 18% with previous DXA had no clinical risk factors for osteoporosis.

Conclusions

DXA was infrequent in this group of elderly men, despite the presence of risk factors for osteoporosis. DXA was also used despite a low fracture risk. There is a need for improved targeting of DXA scans for men at high risk.

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References

  1. van Staa TP, Dennison EM, Leufkens HG, Cooper C (2001) Epidemiology of fractures in England and Wales. Bone 29(6):517–522

    Article  PubMed  Google Scholar 

  2. Sambrook PN, Seeman E, Phillips SR, Ebeling PR (2002) Preventing osteoporosis: outcomes of the Australian Fracture Prevention Summit. Med J Aust 176(Suppl):S1–S16

    PubMed  Google Scholar 

  3. Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH (2002) Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med 162(19):2217–2222

    Article  PubMed  Google Scholar 

  4. Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 10:1633–1650

    Article  Google Scholar 

  5. MacLean C, Newberry S, Maglione M, McMahon M, Ranganath V, Suttorp M et al (2008) Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. Ann Intern Med 148(3):197–213

    PubMed  Google Scholar 

  6. Schousboe JT, Taylor BC, Fink HA, Kane RL, Cummings SR, Orwoll ES et al (2007) Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men. JAMA 298(6):629–637

    Article  PubMed  CAS  Google Scholar 

  7. Vestergaard P, Rejnmark L, Mosekilde L (2005) Osteoporosis is markedly underdiagnosed: a nationwide study from Denmark. Osteoporos Int 16(2):134–141

    Article  PubMed  Google Scholar 

  8. Abrahamsen B, Vestergaard P (2010) Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997–2006. Osteoporos Int 21(3):373–380

    Article  PubMed  CAS  Google Scholar 

  9. Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J et al (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18(8):1033–1046

    Article  PubMed  CAS  Google Scholar 

  10. Cummings SR, Cawthon PM, Ensrud KE, Cauley JA, Fink HA, Orwoll ES (2006) BMD and risk of hip and nonvertebral fractures in older men: a prospective study and comparison with older women. J Bone Miner Res 21(10):1550–1556

    Article  PubMed  Google Scholar 

  11. Ewald DP, Eisman JA, Ewald BD, Winzenberg TM, Seibel MJ, Ebeling PR et al (2009) Population rates of bone densitometry use in Australia, 2001–2005, by sex and rural versus urban location. Med J Aust 190(3):126–128

    PubMed  Google Scholar 

  12. Jones G, Nguyen T, Sambrook PN, Kelly PJ, Gilbert C, Eisman JA (1994) Symptomatic fracture incidence in elderly men and women: the Dubbo Osteoporosis Epidemiology Study (DOES) 82. Osteoporos Int 4(5):277–282

    Article  PubMed  CAS  Google Scholar 

  13. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733

    Article  PubMed  CAS  Google Scholar 

  14. Geusens P, Dinant G (2007) Integrating a gender dimension into osteoporosis and fracture risk research. Gend Med 4(Suppl B):S147–S161

    Article  PubMed  Google Scholar 

  15. Morris CA, Cabral D, Cheng H, Katz JN, Finkelstein JS, Avorn J et al (2004) Patterns of bone mineral density testing: current guidelines, testing rates, and interventions. J Gen Intern Med 19(7):783–790

    Article  PubMed  Google Scholar 

  16. Papaioannou A, Kennedy CC, Ioannidis G, Gao Y, Sawka AM, Goltzman D et al (2008) The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study. Osteoporos Int 19(4):581–587

    Article  PubMed  CAS  Google Scholar 

  17. Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19(4):385–397

    Article  PubMed  CAS  Google Scholar 

  18. Neuner JM, Zhang X, Sparapani R, Laud PW, Nattinger AB (2007) Racial and socioeconomic disparities in bone density testing before and after hip fracture. J Gen Intern Med 22(9):1239–1245

    Article  PubMed  Google Scholar 

  19. Demeter S, Leslie WD, Lix L, MacWilliam L, Finlayson GS, Reed M (2007) The effect of socioeconomic status on bone density testing in a public health-care system. Osteoporos Int 18(2):153–158

    Article  PubMed  CAS  Google Scholar 

  20. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40(5):373–383

    Article  PubMed  CAS  Google Scholar 

  21. Ryg J, Nissen N, Nielsen D, Brixen KT (2005) Patients' and population's knowledge of osteoporosis. Ugeskr Laeger 167(3):282–285

    PubMed  Google Scholar 

  22. Gaines JM, Marx KA, Caudill J, Parrish S, Landsman J, Narrett M et al (2010) Older men's knowledge of osteoporosis and the prevalence of risk factors. J Clin Densitom 13(2):204–209

    Article  PubMed  Google Scholar 

  23. Doheny MO, Sedlak CA, Estok PJ, Zeller R (2007) Osteoporosis knowledge, health beliefs, and DXA T-scores in men and women 50 years of age and older. Orthop Nurs 26(4):243–250

    Article  PubMed  Google Scholar 

  24. Otmar R, Henry MJ, Kotowicz MA, Nicholson GC, Korn S, Pasco JA (2010) Patterns of treatment in Australian men following fracture. Osteoporos Int 22:249–254

    Article  PubMed  Google Scholar 

  25. Bliuc D, Eisman JA, Center JR (2006) A randomized study of two different information-based interventions on the management of osteoporosis in minimal and moderate trauma fractures. Osteoporos Int 17(9):1309–1317

    Article  PubMed  CAS  Google Scholar 

  26. Rubin KH, Abrahamsen B, Hermann AP, Bech M, Gram J, Brixen K (2011) Prevalence of risk factors for fractures and use of DXA scanning in Danish women. A regional population-based study. Osteoporos Int. doi:10.1007/s00198-010-1348-5

  27. Kanis JA, Johnell O (2005) Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int 16(3):229–238

    Article  PubMed  CAS  Google Scholar 

  28. Haapanen N, Miilunpalo S, Pasanen M, Oja P, Vuori I (1997) Agreement between questionnaire data and medical records of chronic diseases in middle-aged and elderly Finnish men and women. Am J Epidemiol 145(8):762–769

    Article  PubMed  CAS  Google Scholar 

  29. Kehoe R, Wu SY, Leske MC, Chylack LT Jr (1994) Comparing self-reported and physician-reported medical history. Am J Epidemiol 139(8):813–818

    PubMed  CAS  Google Scholar 

  30. Bush TL, Miller SR, Golden AL, Hale WE (1989) Self-report and medical record report agreement of selected medical conditions in the elderly. Am J Public Health 79(11):1554–1556

    Article  PubMed  CAS  Google Scholar 

  31. Paganini-Hill A, Chao A (1993) Accuracy of recall of hip fracture, heart attack, and cancer: a comparison of postal survey data and medical records. Am J Epidemiol 138(2):101–106

    PubMed  CAS  Google Scholar 

  32. Brennan SL, Henry MJ, Wluka AE, Nicholson GC, Kotowicz MA, Pasco JA (2010) Socioeconomic status and bone mineral density in a population-based sample of men. Bone 46(4):993–999

    Article  PubMed  Google Scholar 

  33. Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Hanna F, Wluka AE (2009) The association between socioeconomic status and osteoporotic fracture in population-based adults: a systematic review. Osteoporos Int 20(9):1487–1497

    Article  PubMed  CAS  Google Scholar 

  34. Vestergaard P, Rejnmark L, Mosekilde L (2006) Socioeconomic aspects of fractures within universal public healthcare: a nationwide case-control study from Denmark. Scand J Public Health 34(4):371–377

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors are grateful to Jette Kotsis for her help with the computerized management of the questionnaires. The study received financial support from the Novo Nordisk Foundation and the Velux Foundation.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Endocrinology, Odense University Hospital, DK-5000, Odense, Denmark

    M. Frost, C. Gudex, K. H. Rubin & K. Brixen

  2. Clinical Research Institute, University of Southern Denmark, Odense, Denmark

    M. Frost, K. H. Rubin, K. Brixen & B. Abrahamsen

  3. Department of Medicine F, Copenhagen University Hospital Gentofte, Copenhagen, Denmark

    B. Abrahamsen

Authors
  1. M. Frost
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  2. C. Gudex
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  3. K. H. Rubin
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  4. K. Brixen
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  5. B. Abrahamsen
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Correspondence to M. Frost.

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Frost, M., Gudex, C., Rubin, K.H. et al. Pattern of use of DXA scans in men: a cross-sectional, population-based study. Osteoporos Int 23, 183–191 (2012). https://doi.org/10.1007/s00198-011-1589-y

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  • DOI: https://doi.org/10.1007/s00198-011-1589-y

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