Clinical Orthopaedics and Related Research®

, Volume 469, Issue 7, pp 1900–1905 | Cite as

Gender Differences in Osteoporosis and Fractures

Symposium: AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium

Abstract

Background

Osteoporosis is generally thought of as a “woman’s disease” because the prevalence of osteoporosis and the rate of fractures are much higher in postmenopausal women than in older men. However, the absolute number of men affected by osteoporosis and fractures is large, as at least 2.8 million men in the United States are thought to have osteoporosis.

Questions/purposes

The purposes of this review are to (1) highlight gender differences in osteoporosis and fracture risk, (2) describe disparities in treatment and outcomes after fractures between men and women, and (3) propose solutions to reducing disparities in treatment and prevention.

Methods

A literature survey was conducted using MEDLINE with a variety of search terms and using references from the author’s personal collection of articles. A formal search strategy and exclusion criteria were not employed and the review is therefore selective.

Where are we now?

Postmenopausal women have a higher prevalence of osteoporosis and greater incidence of fracture than older men. Despite the higher fracture risk in postmenopausal women, older men tend to have worse outcomes after fracture and poorer treatment rates, although less is known about the disease course in men. Multifaceted interventions to improve the screening and treatment for osteoporosis were recently developed.

Where do we need to go?

Improvement in treatment rates of those at risk, regardless of gender, is an important goal in osteoporosis management.

How do we get there?

Further development and evaluation of cost-effective, multifaceted interventions for screening and treatment of osteoporosis and fractures are needed; such interventions will likely improve the primary prevention of fractures.

References

  1. 1.
    Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Lewiecki EM, Silverman S. Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference. J Clin Densitom. 2008;11:75–91.PubMedCrossRefGoogle Scholar
  2. 2.
    Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007;356:1809–1822.PubMedCrossRefGoogle Scholar
  3. 3.
    Bogoch ER, Elliot-Gibson V, Beaton DE, Jamal SA, Josse RG, Murray TM. Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment. J Bone Joint Surg Am. 2006;88:25–34.PubMedCrossRefGoogle Scholar
  4. 4.
    Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007;22:465–475.PubMedCrossRefGoogle Scholar
  5. 5.
    Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, Palermo L, Prineas R, Rubin SM, Scott JC, Vogt T, Wallace R, Yates AJ, LaCroix AZ. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA. 1998;280:2077–2082.PubMedCrossRefGoogle Scholar
  6. 6.
    Cummings SR, Cawthon PM, Ensrud KE, Cauley JA, Fink HA, Orwoll ES. BMD and risk of hip and nonvertebral fractures in older men: a prospective study and comparison with older women. J Bone Miner Res. 2006;21:1550–1556.PubMedCrossRefGoogle Scholar
  7. 7.
    Cummings SR, Ensrud K, Delmas PD, LaCroix AZ, Vukicevic S, Reid DM, Goldstein S, Sriram U, Lee A, Thompson J, Armstrong RA, Thompson DD, Powles T, Zanchetta J, Kendler D, Neven P, Eastell R. Lasofoxifene in postmenopausal women with osteoporosis. N Engl J Med. 2010;362:686–696.PubMedCrossRefGoogle Scholar
  8. 8.
    Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, Delmas P, Zoog HB, Austin M, Wang A, Kutilek S, Adami S, Zanchetta J, Libanati C, Siddhanti S, Christiansen C. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009;361:756–765.PubMedCrossRefGoogle Scholar
  9. 9.
    Dell RM, Greene D, Anderson D, Williams K. Osteoporosis disease management: what every orthopaedic surgeon should know. J Bone Joint Surg Am. 2009;91(Suppl 6):79–86.PubMedCrossRefGoogle Scholar
  10. 10.
    Faulkner KG, Orwoll E. Implications in the use of T-scores for the diagnosis of osteoporosis in men. J Clin Densitom. 2002;5:87–93.PubMedCrossRefGoogle Scholar
  11. 11.
    Feldstein AC, Nichols G, Orwoll E, Elmer PJ, Smith DH, Herson M, Aickin M. The near absence of osteoporosis treatment in older men with fractures. Osteoporos Int. 2005;16:953–962.PubMedCrossRefGoogle Scholar
  12. 12.
    Greene D, Dell RM. Outcomes of an osteoporosis disease-management program managed by nurse practitioners. J Am Acad Nurse Pract. 2010;22:326–329.PubMedCrossRefGoogle Scholar
  13. 13.
    Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152:380–390.PubMedGoogle Scholar
  14. 14.
    Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, Chesnut CH 3rd, Brown J, Eriksen EF, Hoseyni MS, Axelrod DW, Miller PD. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA. 1999;282:1344–1352.PubMedCrossRefGoogle Scholar
  15. 15.
    Hawkes WG, Wehren L, Orwig D, Hebel JR, Magaziner J. Gender differences in functioning after hip fracture. J Gerontol A Biol Sci Med Sci. 2006;61:495–499.PubMedGoogle Scholar
  16. 16.
    Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res. 2002;17:716–724.Google Scholar
  17. 17.
    Jennings LA, Auerbach AD, Maselli J, Pekow PS, Lindenauer PK, Lee SJ. Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture. J Am Geriatr Soc. 2010;58:650–657.PubMedCrossRefGoogle Scholar
  18. 18.
    Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ 3rd, O’Neill T, Pols H, Reeve J, Silman A, Tenenhouse A. Predictive value of BMD for hip and other fractures. J Bone Miner Res. 2005;20:1185–1194.PubMedCrossRefGoogle Scholar
  19. 19.
    Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH. Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med. 2002;162:2217–2222.PubMedCrossRefGoogle Scholar
  20. 20.
    Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay R. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int. 1998;8:468–489.PubMedCrossRefGoogle Scholar
  21. 21.
    Maggi S, Kelsey JL, Litvak J, Heyse SP. Incidence of hip fractures in the elderly: a cross-national analysis. Osteoporos Int. 1991;1:232–241.PubMedCrossRefGoogle Scholar
  22. 22.
    Majumdar SR, Beaupre LA, Harley CH, Hanley DA, Lier DA, Juby AG, Maksymowych WP, Cinats JG, Bell NR, Morrish DW. Use of a case manager to improve osteoporosis treatment after hip fracture: results of a randomized controlled trial. Arch Intern Med. 2007;167:2110–2115.PubMedCrossRefGoogle Scholar
  23. 23.
    Majumdar SR, Johnson JA, McAlister FA, Bellerose D, Russell AS, Hanley DA, Morrish DW, Maksymowych WP, Rowe BH. Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial. CMAJ. 2008;178:569–575.PubMedGoogle Scholar
  24. 24.
    McCloskey EV, Beneton M, Charlesworth D, Kayan K, deTakats D, Dey A, Orgee J, Ashford R, Forster M, Cliffe J, Kersh L, Brazier J, Nichol J, Aropuu S, Jalava T, Kanis JA. Clodronate reduces the incidence of fractures in community-dwelling elderly women unselected for osteoporosis: results of a double-blind, placebo-controlled randomized study. J Bone Miner Res. 2007;22:135–141.PubMedCrossRefGoogle Scholar
  25. 25.
    McClung MR, Geusens P, Miller PD, Zippel H, Bensen WG, Roux C, Adami S, Fogelman I, Diamond T, Eastell R, Meunier PJ, Reginster JY. Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med. 2001;344:333–340.PubMedCrossRefGoogle Scholar
  26. 26.
    National Osteoporosis Foundation. America’s Bone Health: The State of Osteoporosis and Low Bone Mass in Our Nation. Washington, DC: National Osteoporosis Foundation; 2002.Google Scholar
  27. 27.
    National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2010.Google Scholar
  28. 28.
    Nguyen ND, Ahlborg HG, Center JR, Eisman JA, Nguyen TV. Residual lifetime risk of fractures in women and men. J Bone Miner Res. 2007;22:781–788.PubMedCrossRefGoogle Scholar
  29. 29.
    Nguyen ND, Pongchaiyakul C, Center JR, Eisman JA, Nguyen TV. Identification of high-risk individuals for hip fracture: a 14-year prospective study. J Bone Miner Res. 2005;20:1921–1928.PubMedCrossRefGoogle Scholar
  30. 30.
    Orwoll E, Ettinger M, Weiss S, Miller P, Kendler D, Graham J, Adami S, Weber K, Lorenc R, Pietschmann P, Vandormael K, Lombardi A. Alendronate for the treatment of osteoporosis in men. N Engl J Med. 2000;343:604–610.PubMedCrossRefGoogle Scholar
  31. 31.
    Otmar R, Henry MJ, Kotowicz MA, Nicholson GC, Korn S, Pasco JA. Patterns of treatment in Australian men following fracture. Osteoporos Int. 2011;22:249–254.PubMedCrossRefGoogle Scholar
  32. 32.
    Riggs BL, Melton LJ 3rd, Robb RA, Camp JJ, Atkinson EJ, Peterson JM, Rouleau PA, McCollough CH, Bouxsein ML, Khosla S. Population-based study of age and sex differences in bone volumetric density, size, geometry, and structure at different skeletal sites. J Bone Miner Res. 2004;19:1945–1954.PubMedCrossRefGoogle Scholar
  33. 33.
    Schousboe JT, Ensrud KE, Nyman JA, Melton LJ 3rd, Kane RL. Universal bone densitometry screening combined with alendronate therapy for those diagnosed with osteoporosis is highly cost-effective for elderly women. J Am Geriatr Soc. 2005;53:1697–1704.PubMedCrossRefGoogle Scholar
  34. 34.
    Schuit SC, van der Klift M, Weel AE, de Laet CE, Burger H, Seeman E, Hofman A, Uitterlinden AG, van Leeuwen JP, Pols HA. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. 2004;34:195–202.PubMedCrossRefGoogle Scholar
  35. 35.
    Sigurdsson G, Aspelund T, Chang M, Jonsdottir B, Sigurdsson S, Eiriksdottir G, Gudmundsson A, Harris TB, Gudnason V, Lang TF. Increasing sex difference in bone strength in old age: The Age, Gene/Environment Susceptibility-Reykjavik study (AGES-REYKJAVIK). Bone. 2006;39:644–651.PubMedCrossRefGoogle Scholar
  36. 36.
    Skedros JG, Holyoak JD, Pitts TC. Knowledge and opinions of orthopaedic surgeons concerning medical evaluation and treatment of patients with osteoporotic fracture. J Bone Joint Surg Am. 2006;88:18–24.PubMedCrossRefGoogle Scholar
  37. 37.
    Vik SA, Jantzi M, Poss J, Hirdes J, Hanley DA, Hogan DB, Maxwell CJ. Factors associated with pharmacologic treatment of osteoporosis in an older home care population. J Gerontol A Biol Sci Med Sci. 2007;62:872–878.PubMedGoogle Scholar
  38. 38.
    Werner P. Knowledge about osteoporosis: assessment, correlates and outcomes. Osteoporos Int. 2005;16:115–127.PubMedCrossRefGoogle Scholar
  39. 39.
    Xu L, Lu A, Zhao X, Chen X, Cummings SR. Very low rates of hip fracture in Beijing, People’s Republic of China: the Beijing Osteoporosis Project. Am J Epidemiol. 1996;144:901–907.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  1. 1.San Francisco Coordinating Center, California Pacific Medical Center Research InstituteSan FranciscoUSA

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