MDNews - Minnesota

W H EN S C R EEN I N G M EE TS CO N V EN I EN C E THE FR A X — Fracture Risk Assessment Tool — is an online questionnaire physicians can complete with their patients during an offi ce visit to provide an accurate glimpse of a patient's 10-year fragility fracture risk. Since June 2011, the FRAX tool — developed through a partner- ship between researchers at the University of Sheffi eld in the United Kingdom and the World Health Organization — has been used to measure fracture risk in more than 10 million individuals worldwide. Results, based on algorithms adjusted for gender and nationality, tell physicians if a patient needs a dual-energy X-ray absorptiometry scan. For more information, visit shef.ac.uk/FRAX/. that if [a patient] has one fragility fracture, [his or her] rate of having a second one is twice as high. If you can intervene, you can have an impact on the patient's life that is more than simply treating the injury." The research team examined not only the incidence of distal radial fracture, but also the rates of DXA screening and subsequent treat- ment with calcium and vitamin D supplementation and/or use of bisphosphonates. Of the 344 women included in the study, 184 — 53 percent — had a DXA scan and 65 were diagnosed with osteoporosis. These women began taking vitamin D and calcium supplements, and nearly all were prescribed a bisphosphonate medication to prevent further bone loss. The medical records of men, however, revealed a startling discrepancy. Only 18 percent of the men in the study received a DXA scan follow- ing their injury. Of these 17 individuals, nine were diagnosed with osteoporosis and began taking vitamin D and calcium supplements. But only three men, a mere 33 percent of those with osteoporosis diagnoses, were treated with a bisphosphonate drug. "[Of] the 17 guys that did have a bone mineral density test, half of them had osteoporosis," says Carl M. Harper, MD, an orthopedic surgeon affi liated with Harvard Medical School and lead author of the paper. "There was no difference in those men and the rest of the cohort who didn't receive the bone density testing. We extrapolated that of those 95 men included in the study, nearly half of them could have had osteoporosis and should have benefi ted from a bone density test." Addressing a Growing Concern The International Osteoporosis Foundation predicts that worldwide the number of men 60 or older will increase tenfold by 2050. This, coupled with the fact that men typically have higher morbidity and mortality rates than women following fragility fractures, indicates a rising need for better osteoporosis management. Misconceptions among both clinicians and the general population regarding the disease's prevalence in males may play a role in the low evaluation and treatment rates observed in men. But a lack of clinical evidence and established treatment guidelines may be a factor as well. According to Dr. Harper, screening guidelines are well-established for older women, and the distal radial study's evaluation rates of women exceed national averages. He acknowledges that in men, however, recent guidelines developed using FRAX — Fracture Risk Assessment Tool — models aren't as well-known or widely accepted. Dr. Rozental adds that these recommendations for men are similar to those established for women, yet this study indicates a very low number of male patients are routinely receiving necessary screening. Changing the conversation that takes place between male patients and their physicians is key to reversing this trend. The researchers call on primary care physicians, endocrinologists and orthopedic surgeons to work together to examine men at risk for osteoporosis and initiate treatment, if necessary. Patient education about osteoporosis and its risk factors is also paramount. "Understand that as the population ages, you're going to see more fragility fractures," Dr. Harper says. "These [fractures] are a signifi cant source of morbidity. It behooves physicians to evaluate men, as well as women, not to prevent but certainly to impact the overall incidence of fragility fractures." ■ M D N E W S . CO M ■ MD NEWS Minnesota | 1 3

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