Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Guidelines Summary
  • Published:

Screening for osteoporosis in men: comment on the American College of Physicians clinical guidelines

Nature Clinical Practice Rheumatology volume 4, pages 626–627 (2008)Cite this article

Osteoporosis is an important clinical problem in men. Men who sustain a hip fracture have excess mortality for up to 2 years following the fracture, and those who survive beyond this period of time are likely to have long-term functional impairment that can result in physical disability as well as increased risk for a second hip fracture.1 Prevention of hip and other osteoporotic fractures in men requires both the identification of those at risk for fracture and the availability of effective treatments to reduce fracture risk. Given that low bone mineral density (BMD) is a major risk factor for hip and other osteoporotic fractures in men as well as women,2,3 it is important to identify those men with osteoporosis or the combination of low BMD and clinical risk factors that portend a clinically important risk of fracture in the foreseeable future.

The recently published American College of Physicians (ACP) clinical guidelines for osteoporosis screening in men included three recommendations (Box 1).4 These guidelines were based on the conclusions of a systematic evidence-based review of risk factors for osteoporosis and fractures in men.5,6 This review identified several risk factors for osteoporosis in this population including age over 70 years, low body weight (BMI<25 kg/m2), weight loss (decline of ≥10% of total body weight), physical inactivity, use of glucocorticoids or androgen-deprivation therapy, and a previous fragility fracture. It is unclear from the ACP guidelines how the presence of these risk factors, either singly or in combination, should be used by the practicing clinician to make a decision to implement recommendation 2; that is, to order measurement of BMD by dual X-ray absorptiometry (DXA).

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Orwig DL et al. (2006) Hip fracture and its consequences: differences between men and women. Orthop Clin North Am 37: 611–622

    Article  Google Scholar 

  2. Johnell O et al. (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194

    Article  Google Scholar 

  3. Cummings SR et al. (2006) BMD and risk of hip and nonvertebral fractures in older men: a prospective study and comparison with older women. J Bone Miner Res 21: 1550–1556

    Article  Google Scholar 

  4. Qaseem A et al. (2008) Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians. Ann Intern Med 148: 680–684

    Article  Google Scholar 

  5. Liu H et al. (2008) Screening for osteoporosis in men: a systematic review for an American College of Physicians guideline. Ann Intern Med 148: 685–701

    Article  Google Scholar 

  6. Shekelle P et al. (2007) Screening men for osteoporosis: who & how. Prepared by the Greater Los Angeles Veterans Affairs Healthcare System/southern California/RAND Evidence-based Practice Center. Washington, DC: US Department of Veterans Affairs

  7. National Osteoporosis Foundation (2008) Clinician's guide to prevention and treatment of osteoporosis. [http://www.nof.org/professionals/Clinicians_Guide.htm] (accessed 1 July 2008)

  8. Baim S et al. (2008) Official positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Pediatric Position Development Conference. J Clin Densitom 11: 6–217.

    Article  Google Scholar 

  9. Schousboe JT et al. (2007) Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men. JAMA 298: 629–37

    Article  CAS  Google Scholar 

  10. Lynn HS et al. (2008) An evaluation of osteoporosis screening tools for the osteoporotic fractures in men (MrOS) study. Osteoporos Int 19: 1087–1092

    Article  CAS  Google Scholar 

  11. WHO Fracture Risk Assessment Tool (FRAX™) [http://www.shef.ac.uk/FRAX/index.htm]

  12. Dawson-Hughes B et al. (2008) Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporos Int 19: 449–458

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. MC Hochberg is Head of the Division of Rheumatology and Clinical Immunology in the Department of Medicine and Professor of Medicine and of Epidemiology and Preventive Medicine at University of Maryland School of Medicine, Baltimore, MD,

    Marc C Hochberg

  2. RA Adler is Chief of Endocrinology and Metabolism at McGuire Veterans Affairs Medical Center, and Professor of Internal Medicine and of Epidemiology and Community Health at Virginia Commonwealth University, Richmond, VA, USA.,

    Robert A Adler

Authors
  1. Marc C Hochberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert A Adler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marc C Hochberg.

Ethics declarations

Competing interests

MC Hochberg has been a consultant for Amgen, Merck, Novartis, Roche and Wyeth. RA Adler has been has been a consultant for Eli Lilly, Merck and Novartis, received speakers' fees from Merck, Novartis and Proctor & Gamble, and received grant/research support from Eli Lilly, GlaxoSmithKline, Novartis and Proctor & Gamble.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hochberg, M., Adler, R. Screening for osteoporosis in men: comment on the American College of Physicians clinical guidelines. Nat Rev Rheumatol 4, 626–627 (2008). https://doi.org/10.1038/ncprheum0923

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncprheum0923

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing