Osteoporosis International

, Volume 23, Issue 3, pp 1041–1051 | Cite as

Treatment for older men with fractures

  • A. J. Shepherd
  • A. R. Cass
  • L. A. Ray
  • A. Tan
  • G. S. Wilkinson
Original Article



Less than 10% of men receive osteoporosis treatment, even after a fracture. A study of 17,683 men revealed that older men, those with spinal fractures, and those taking steroids or antidepressants are more likely to receive treatment after a fracture. Seeing a primary care physician also increases osteoporosis treatment rates.


In 2000, the FDA approved bisphosphonates for the treatment of osteoporosis in men. The purpose of this study is to estimate the frequency of bisphosphonate therapy within 12 months following a fracture and describe patient/physician factors associated with treatment.


Health insurance claims for 17,683 men ≥65 years of age, who had a claim for an incident fracture from 2000 to 2005, were followed for at least 6 months post-fracture for the initiation of treatment with a bisphosphonate. Patient characteristics, diagnostic procedures, therapies, co-morbidities, and provider characteristics were compared for men who received treatment with those who did not.


Eight percent of men (n = 1,434) received bisphosphonate therapy. Overall treatment increased from 7% in 2001 to 9% in 2005 (p < 0.001). Treatment for hip fractures remained at 7% (p = 0.747). Treatment increased with age: 6% in men aged 65–69 compared to 11.6% in men aged 85–89 (p < 0.001). Factors associated with treatment included: diagnosis of osteoporosis (OR = 8.8; 95% CI, 7.7, 10.4), glucocorticoid therapy (OR = 3.2; 95% CI, 2.4, 4.3), bone mineral density measurement (OR = 3.4; 95% CI, 2.9, 4.0), and antidepressant therapy with tricyclics (OR = 2.0; 95% CI, 1.2, 3.5) or selective serotonin reuptake inhibitors (OR = 1.7; 95% CI, 1.3, 2.4). Men with vertebral fractures (OR = 2.2; 95% CI, 1.8, 2.6) and men seen by primary physicians (OR = 2.6; 95% CI, 2.3, 3.1) were more likely to receive treatment.


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.


Bisphosphonates Fractures Men Osteoporosis 



This study was supported by a grant from the AAFP Foundation Joint Grant Awards Program (grant number: G0811).

Conflicts of interest



  1. 1.
    Kanis J, Johnell O, Gullberg B, Allander E, Elfors L, Ranstam J, Dequeker J, Dilsen G, Gennari CLVA, Lyritis G, Mazzuoli G, Miravet L, Passeri M, Perez Cano R, Rapado A, Ribot C (1999) Risk factors for hip fracture in men from Southern Europe: the MEDOS Study. Osteoporos Int 9:45–54PubMedCrossRefGoogle Scholar
  2. 2.
    Hoffenberg R, James O, Brocklehurst J, Green I, Horrocks O, Kanis J, Wald N, MacLellan G, Vickers R, Hibbs P, Halliday N, Pyke D (1989) Fractured neck of femur. Prevention and management. J R Coll Physicians Lond 23:8–12Google Scholar
  3. 3.
    Forsen L, Sogaard A, Meyer H, Edna T, Kopjar B (1999) Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteoporos Int 10:73–78PubMedCrossRefGoogle Scholar
  4. 4.
    Center J, Nguyen T, Schneider D, Sambrook P, Eisman J (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882PubMedCrossRefGoogle Scholar
  5. 5.
    Orwoll E, Ettinger M, Weiss S, Miller P, Kendler D, Graham J, Adami S, Weber K, Roman L, Pietschmann P, Vandormael K, Lombardi A (2000) Alendronate for the treatment of osteoporosis in men. N Engl J Med 343:604–610PubMedCrossRefGoogle Scholar
  6. 6.
    Gonnelli S, Cepollaro C, Montagnani AM, Bruni D, Caffarelli C, Breschi M, Gennari L, Gennari C, Nuti R (2003) Alendronate treatment in men with primary osteoporosis: a three year longitudinal study. Calcif Tissue Int 73:133–139PubMedCrossRefGoogle Scholar
  7. 7.
    Sato Y, Iwamoto J, Kanoko T, Satoh K (2005) Risedronate sodium therapy for prevention of hip fracture in men 65 years or older after stroke. Arch Intern Med 165:1743–1748PubMedCrossRefGoogle Scholar
  8. 8.
    US Department of Health and Human Services (2010) Healthy People 2010. Accessed 5 May 2011
  9. 9.
    Kamel H, Mohammad S, Tariq S, Perry HI, Morley J (2000) Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture. Am J Med 109:326–328PubMedCrossRefGoogle Scholar
  10. 10.
    Kiebzak G, Beinart G, Perser K, Ambrose C, Siff S, Heggeness M (2002) Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med 162:2217–2222PubMedCrossRefGoogle Scholar
  11. 11.
    Feldstein A, Nichols G, Orwoll E, Elmer P, Smith D, Herson M, Aickin M (2005) The near absence of osteoporosis treatment in older men with fractures. Osteoporos Int 16:953–962PubMedCrossRefGoogle Scholar
  12. 12.
    Cuddihy M, Amadio P, Melton L (2002) Patient barriers to osteoporosis interventions after fracture. Mayo Clinic Proceedings 77, August 2002Google Scholar
  13. 13.
    Seeley D, Browner W, Nevitt M, Genant H, Scott J, Cummings S (1991) Which fractures are associated with low appendicular bone mass in elderly women? The Study of Osteoporotic Fractures Research Group. Ann Intern Med 115:837–842PubMedGoogle Scholar
  14. 14.
    Charlson M, Pompei P, Ales K, MacKenzie C (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRefGoogle Scholar
  15. 15.
    Deyo R, Cherkin D, Ciol M (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619PubMedCrossRefGoogle Scholar
  16. 16.
    Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J, Saunders L, Beck C, Feasby T, Ghali W (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–1139PubMedCrossRefGoogle Scholar
  17. 17.
    Favus M (ed) (1999) Primer on the metabolic bone diseases and disorders of mineral metabolism. Lippincott, Williams and Wilkins, PhiladelphiaGoogle Scholar
  18. 18.
    American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis (2001) Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update. Arthritis Rheum 44:1496–1503CrossRefGoogle Scholar
  19. 19.
    Eustice C, Eustice R (2006) The facts of corticosteroids (steroids). 2009
  20. 20.
    Bolton J, Metge C, Lix L, Prior H, Sareen J, Leslie W (2008) Fracture risk from psychotropic medications. J Clin Psychopharmacol 28:384–391PubMedCrossRefGoogle Scholar
  21. 21.
    Lewis C, Ewing S, Taylor B, Shikany J, Fink H, Ensrud K, Barrett-Connor E, Cummings S, Orwoll E (2007) Predictors of non-spine fracture in elderly men: the MrOS study. J Bone Miner Res 22:211–219PubMedCrossRefGoogle Scholar
  22. 22.
    Richards J, Papaioannou A, Adachi J, Joseph L, Whitson H, Prior J, Goltzman D (2007) Effect of selective serotonin reuptake inibitors on the risk of fracture. Arch Intern Med 167:188–194PubMedCrossRefGoogle Scholar
  23. 23.
    Vestergaard P, Rejnmark L, Mosekilde L (2006) Anxiolytics, sedatives, antidepressants, neuroleptics and the risk of fracture. Osteoporos Int 17:807–816PubMedCrossRefGoogle Scholar
  24. 24.
    Vestergaard P, Rejnmark L, Mosekilde L (2008) Selective serotonin reuptake inhibitors and other antidepressants and risk of fracture. Calcif Tissue Int 82:92–101PubMedCrossRefGoogle Scholar
  25. 25.
    Ziere G, Dieleman J, van der Cammen T, Hofman A, Pols H, Stricker B (2008) Selective serotonin reuptake inhibiting antidepressants are associated with an increased risk of nonvertebral fractures. J Clin Psychopharmacol 28:411–417PubMedCrossRefGoogle Scholar
  26. 26.
    Armitage P (1955) Tests for linear trends in proportions and frequencies. Biometrics 11:375–386CrossRefGoogle Scholar
  27. 27.
    Cochran W (1954) Some methods for strengthening the common chi-square tests. Biometrics 10:417–451CrossRefGoogle Scholar
  28. 28.
    SAS Institute I (2006) SAS/STAT user's guide. SAS Institute Inc., CaryGoogle Scholar
  29. 29.
    Colon-Emeric C, Sloane R, Hawkes W, Magaziner J, Zimmerman S, Pieper C, Lyles K (2000) The risk of subsequent fractures in community-dwelling men and male veterans with hip fracture. Am J Med 109:324–326PubMedCrossRefGoogle Scholar
  30. 30.
    Cummings S, Nevitt M, Browner W, Stone K, Fox K, Ensrud K, Cauley J, Black D, Vogt T (1995) Risk factors for hip fracture in white women. N Engl J Med 332:767–773PubMedCrossRefGoogle Scholar
  31. 31.
    Freedman K, Kaplan F, Bilker W, Strom B, Lowe R (2000) Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am 82-A:1063–1070PubMedGoogle Scholar
  32. 32.
    Johansson C, Mellstrom D (1996) An earlier fracture risk factor for new fracture and its association with smoking and menopausal age in women. Maturitas 24:97–106PubMedCrossRefGoogle Scholar
  33. 33.
    Klotzbuecher C, Ross P, Landsman P, Abbott T III, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739PubMedCrossRefGoogle Scholar
  34. 34.
    Mallmin H, Ljunghal S, Persson I, Naessen T, Krusemo U, Bergstrom R (1993) Fracture of the distal forearm as a forecaster of subsequesnt hip fracture: a population-based cohort study with 24 years of follow-up. Calcif Tissue Int 52:269–272PubMedCrossRefGoogle Scholar
  35. 35.
    Owen R, Melton L III, Ilstrup D, Riggs B (1982) Colles' fracture and subsequent hip fracture risk. Clin Orthop 171:37–43PubMedGoogle Scholar
  36. 36.
    Ringe J, Dorst A, Faber H, Ibach K (2004) Alendronate treatment of established primary osteoporosis in men: 3-year results of a prospective, comparative, two-arm study. Rheumatol Int 24:110–113PubMedCrossRefGoogle Scholar
  37. 37.
    Juby A, De Geus-Wenceslau C (2002) Evaluation of osteoporosis treatment in seniors after hip fracture. Osteoporos Int 13:205–210PubMedCrossRefGoogle Scholar
  38. 38.
    Sato Y, Honda Y, Iwamoto J (2007) Risedronate and ergocalciferol prevent hip fracture in elderly men with Parkinsons disease. Neurology 68:911–915PubMedCrossRefGoogle Scholar
  39. 39.
    Solomon D, Morris C, Cheng H, Cabral D, Katz J, Finkelstein J, Avorn J (2005) Medication use patterns for osteoporosis: an assessment of guidelines, treatment rates, and quality improvement interventions. Mayo Clin Proc 80:194–202PubMedCrossRefGoogle Scholar
  40. 40.
    Chapuy M, Arlot M, Duboeuf F, Brun J, Crouzet B, Arnold S, Delmas P, Meunier P (1992) Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 327:1637–1642PubMedCrossRefGoogle Scholar
  41. 41.
    Dawson-Hughes B, Harris S, Krall E, Dallal G (1997) Effect of calcium and vitamin D. Supplement on bone density in men and women 65 years of age or older. N Engl J Med 337:670–676PubMedCrossRefGoogle Scholar
  42. 42.
    Kaufman J (1995) Role of calcium and vitamin D in the prevention and the treatment of postmenopausal osteoporosis: an overview. Clin Rheumatol 14:9–13PubMedCrossRefGoogle Scholar
  43. 43.
    Kaufman J, Devogelaer J, Raeman F, Rozenberg S, Body J, Westhovens R, Reginster J (1996) Prevention and treatment of postmenopausal osteoporosis. National Consensus of the “Belgian bone Club”. Clin Rheumatol 16:343–345CrossRefGoogle Scholar
  44. 44.
    Murray T (1996) Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 4. Calcium nutrition and osteoporosis. Can Med Assoc J 155:935–939Google Scholar
  45. 45.
    Kuo I, Ong C, Simmons L, Bliuc D, Eisman J, Center J (2007) Successful direct intervention for osteoporosis in patients with minimal trauma fractures. Osteoporos Int 18:1633–1639PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • A. J. Shepherd
    • 1
  • A. R. Cass
    • 1
  • L. A. Ray
    • 2
    • 1
  • A. Tan
    • 3
  • G. S. Wilkinson
    • 2
    • 1
  1. 1.Department of Family MedicineThe University of Texas Medical BranchGalvestonUSA
  2. 2.Department of Preventive Medicine & Community HealthThe University of Texas Medical BranchGalvestonUSA
  3. 3.Office of BiostatisticsThe University of Texas Medical BranchGalvestonUSA

Personalised recommendations