Older men are missing out on routine osteoporosis tests

Are you surprised that men do not have bone density tests routinely?

While all major health organizations recommend osteoporosis screening for women over 65, there are no consistent guidelines for screening older men. A new study presented at ACR Convergence (The American College Rheumatology’s annual meeting) highlighted this problem. Even after significant fractures, treatment rates remained low among older men, leaving them at risk of another fracture.

In this study, the researchers investigated Medicare fee-for-service (FFS) beneficiaries who had a fracture between January 2010 and September 2014.

The main inclusion criteria for the study are:
• Patient aged 65 or older, who had continuous enrollment for a minimum of one year before the index date through at least one month after;
• Excluding those who died within 30 days of the index date;
• Excluding those with either Paget’s disease or any malignancy, except non-melanoma skin cancer, at baseline.

The investigation included 9,876 Medicare members, of which 61% were 75 or older, and 90% were white.

Results and findings:

• Fewer than 6% had a standard bone density test with dual-energy x-ray absorptiometry (DXA) in the two years before fracture.
• Two-thirds of the patients had musculoskeletal pain history. Nearly half had used opioids one year before their fracture.
• The most common fractures were that of the spine, hip, and ankle.
• About 92% did not claim a DXA test or osteoporosis treatment two years before their fracture.
• 2.8% had been tested and not treated, 2.3% were treated but not tested, and only 2.1% were tested and treated for osteoporosis.
• DXA scans were exceptionally low from 2012 to 2014 among men aged 75 and older. It is known that men at this age are more vulnerable to fractures.

The study concluded that a high proportion of older men at risk of fractures did not have screening tests and osteoporosis treatment. Screening tests can help to identify high-risk male patients who might benefit from early diagnosis and therapies.

“There is a need for consistent osteoporosis screening recommendation in men,” said Dr. Jeffrey Curtis, co-author of the paper. “Incorporation of these recommendations in quality-of-care measures for osteoporosis management and post-fracture care is warranted to improve health outcomes in this population,” he commented.

Dr. Curtis is Professor of Medicine, Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham.

Osteoporosis is underdiagnosed and undertreated in older men. https://www.eurekalert.org/pub_releases/2020-11/acor-oiu110520.php

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Walking downhill increases the risk of falls in older adults

Older people should exercise regularly to improve strength and balance. However, suppose you are new to physical exercise or have been inactive for a long time. In that case, the muscle soreness and stiffness after exercise may increase the risk of falling. The point is particularly true if the training involves eccentric contraction of the muscles, such as walking downhill and squatting.

An eccentric contraction happens when the muscle lengthens under a load or tension. In the squat exercise, the quadriceps muscles contract ‘eccentrically’ as we go down. Similarly, when we walk downhill, descend stairs, or go from standing to sitting position, the muscles in our thighs lengthen under the load of the body.

In concentric contraction, the activated muscle shortens as it generates force against resistance or load. An example of concentric contraction is raising a weight during a biceps curl. Climbing stairs or getting out of a chair involves concentric muscle contraction too.

Why are we concerned?

This study divided participants aged 65-78 years into two groups:

  • Group 1 took part in mainly concentric contractions (walking on a level surface)
  • Group 2 took part in mainly eccentric contractions (downhill walking)

Following the workout, the researchers checked the participants’ recovery of muscle strength, balance, and physical function at 30 minutes and 24 to 48 hours later.

Results and findings:

• The concentric exercise group experienced muscle weakness and impaired function immediately after the exercise. However, the adverse effects were temporary, and all participants recovered to pre-exercise levels around 30 minutes after stopping the activity.
• In the eccentric exercise group, although the participants experienced muscle weakness, there was no change in balance and physical function 30 minutes after exercise. However, people had substantial losses of balance, physical function, and muscle weakness 24 hours after training. They remained impaired at least 48 hours after exercise.

These findings suggest that muscle damage due to unaccustomed eccentric exercise leads to muscle weakness, balance problems, and impaired physical function. The effects can persist for several days. During this period, an older person might have an increased risk of falling.

Walking downhill increases the risk of falls in older adults. https://medicalxpress.com/news/2020-11-downhill-falls-older-adults.html


Vegetarians and vegans are at greater risk of bone fractures

EPIC-Oxford has recently published in BMC Medicine the result of their study on the association of diet and bone health. They found that non-meat eaters, especially vegans, are at greater risk of bone fractures.

The European Prospective Investigation into Cancer and Nutrition (EPIC) was initiated in 1992. It is an ongoing prospective cohort study across ten European countries on the relationship between nutrition and cancer and other chronic diseases. Between 1993 and 2001, it has enrolled more than half a million participants, mostly aged 35–70. Baseline data, including diet, socio-demographic characteristics, lifestyle, and medical history, were collected. Researchers will follow these participants’ health outcomes for several decades.

For the present study on bone health, the Oxford center of EPIC categorized the UK recruits into four diet groups: 29,380 meat-eaters, 8037 fish-eaters, 15,499 vegetarians, and 1982 vegans. They follow these participants’ fracture histories until mid-2016, over an average of 17.6 years of follow-up.

The researchers noted the first recorded hospital admission or death from any and site-specific fractures. The collected data include fractures of the arm (humerus, radius, and ulna), wrist, hip, leg (patella, tibia, fibula, and femur but excluding head of the femur), ankle, and other prominent sites (clavicle, rib, or vertebra).

With meat-eater as a reference point, the study found that:

  • In all fracture incidences, vegetarians had a 9 percent increased risk, and vegans a 43 percent increased risk than meat-eater.
  • In hip fracture, while vegetarians and fish-eaters had about 25 percent increased risk, the vegans’ risk was more than twice that of meat-eaters.
  • The risk for leg, vertebral, and arm fracture was also higher in vegans than in meat-eaters.

“These risk differences were likely partly due to their lower BMI, and possibly to lower intakes of calcium and protein. More studies are needed, especially from non-European and contemporary populations, to examine the generalisability of our findings and to explore possible heterogeneity by factors including age, sex, menopausal status, and BMI. Future work might benefit from examining possible biological pathways by investigating serum levels of vitamin D, vitamin B12, or IGF-1, or in assessing the possible roles of other nutrients that are abundant in animal-sourced foods,” The study concluded.


Tong, T.Y.N., Appleby, P.N., Armstrong, M.E.G., et al. Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study. BMC Med 18, 353 (2020). https://doi.org/10.1186/s12916-020-01815-3

European Prospective Investigation into Cancer and Nutrition

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