Controversy surrounding osteoporosis screening in older men has sparked a debate and raised questions about the guidelines for when men should be screened for the condition. Many believe that screening is only necessary for men over 70 who have already experienced a fracture. However, there is growing concern that this approach may not be sufficient and that more proactive screening measures should be implemented.
One woman, B.W., describes her confusion and frustration with the current guidelines. Her husband was only advised to get a DEXA (dual-energy X-ray absorptiometry) scan after experiencing back pain and multiple compression fractures of the thoracic spine at the age of 72. It wasn’t until then that his T-score revealed a significant reduction in bone density, with a score of -2.8 for his spine.
B.W. can’t help but feel that her husband’s condition went unnoticed for too long. Despite being male, weighing 200 pounds, and maintaining an active lifestyle, the issue of osteoporosis was never addressed during his yearly primary care visits. Even though his height had gradually decreased since 2019, there was no mention of the possibility of osteoporosis until he experienced severe back pain and fractures. B.W. expresses her concern that osteoporosis seems to receive less attention when it comes to men, and she questions why a simple, fast, painless, and relatively inexpensive screening test is not ordered earlier for men.
In general, screening tests are conducted on individuals who do not exhibit any symptoms of a particular condition. These tests are recommended when there is substantial evidence that screening can lead to improved outcomes compared to not being screened. The data supporting osteoporosis screening in women is strong enough that all women over 65 and those under 65 with additional risk factors should undergo a DEXA scan. However, for men, there is not enough strong evidence to support routine screening.
The topic of osteoporosis screening in men remains controversial. While some influential groups recommend against screening all men over 70, there are other groups that advocate for earlier screening, despite the lack of proven benefits. Their rationale is based on the fact that the test is relatively safe, with minimal radiation exposure, and reasonably priced (averaging around $150). Nevertheless, one significant drawback of screening tests is their lack of perfection. Therefore, if osteoporosis is unexpectedly detected in a man, the screening test must be repeated to ensure the accuracy of the results.
However, there are certain medical findings in men that should prompt consideration for a DEXA scan. For instance, a significant loss of height, exceeding 1.5 inches, could be an indicator for osteoporosis and would warrant further evaluation. Additionally, risk factors such as low testosterone levels (hypogonadism), primary hyperparathyroidism, inflammatory bowel disease, and prolonged use of certain medications like prednisone should initiate a discussion about the possibility of osteoporosis and the need for a DEXA scan. Similarly, if osteoporosis is diagnosed in a man, it is crucial to investigate the underlying causes, which may include any of the aforementioned risk factors.
In conclusion, the controversy surrounding osteoporosis screening in older men continues to stimulate debate and raise important questions about current guidelines. While routine screening for men is not widely recommended due to insufficient evidence of its benefits, there are instances where a DEXA scan should be considered based on individual medical findings and risk factors. It is crucial to strike a balance between proactive screening and avoiding unnecessary testing. Further research is needed to clarify the guidelines and ensure that all individuals, regardless of gender, receive appropriate and timely osteoporosis screening.
