Osteoporosis Screening Rates In Men With Risk Factors
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Screening Men For Osteoporosis
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Author : U. S. Department of Veterans Affairs
language : en
Publisher: Createspace Independent Pub
Release Date : 2013-06-18
Screening Men For Osteoporosis written by U. S. Department of Veterans Affairs and has been published by Createspace Independent Pub this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013-06-18 with Medical categories.
Although the Surgeon General's recent report on osteoporosis stated that, “Strong bones (are) essential to overall health and quality of life,” it warned that, “The bone health status of Americans… is in jeopardy.” Traditionally, osteoporosis was viewed as a disease of women, but it has become clear that osteoporotic fractures result in substantial morbidity, mortality, and costs in men. A 60-year old man has a 25% lifetime risk of sustaining an osteoporotic fracture. The consequences of this fracture can be severe as the one-year mortality rate in men after hip fracture is twice that of women. With the aging of the population, rates of osteoporosis in men are expected to increase nearly 50% in the next 15 years and hip fractures rates are projected to double or triple by 2040. Furthermore, annual U.S. direct medical costs for osteoporosis exceed $17 billion and are expected to increase rapidly with an aging population. The percentage of costs directly attributable to men or veterans is unclear, although 25% of hip fractures, the fracture type associated with greatest costs due to hospitalization and long-term care, occur in men. This large and growing clinical and cost burden, combined with an environment of increasingly limited health care resources, strongly underlies the need to develop rational, evidence-based osteoporosis management strategies to obtain maximum benefit for every health care dollar spent. Despite the substantial advances in our understanding of osteoporosis over the last decade, there are no consensus guidelines on the assessment and management of male osteoporosis. Although osteoporosis management strategies have been evaluated in women, much less work has been done in this area in men. Lack of research in this area has led to considerable uncertainty regarding optimal osteoporosis strategies in men and Veterans. The VA Office of Quality and Performance and the U.S. Preventive Services Task Force offer no clinical practice guidelines on the management of osteoporosis in men. This review is being performed as part of the Evidence Synthesis Project, an HSR&D-organized initiative to provide VA policymakers with high quality evidence reviews. The purpose of this review is to analyze the literature in order to answer three key questions: 1) What is the epidemiology and what are the key risk factors for male osteoporosis?; 2) Are there any validated screening tools for osteoporosis in men (beyond DXA-assessed central bone density)?; and 3) What is the evidence regarding bone mineral density and fracture risk? Although 25% of men over the age of 60 will sustain osteoporotic fractures during their lifetime, data suggest that male osteoporosis is underdiganosed and undertreated. In order to help inform decisions about whether the Veterans Health Administration should develop screening guidelines for male osteoporosis, summaries of what is known about 1) the epidemiology of male osteoporosis, and 2) the validity of tools to screen and diagnose male osteoporosis are needed. The Key Questions were: Key Question 1. What are the prevalence of and risk factors for osteopenia, osteoporosis and osteoporotic fractures among men in general and among male Veterans specifically? Key Question 2. Are there any validated tools (outside of central bone density) to screen for osteoporosis in men? Key Question 3. What values of BMD determined by Dual energy X-ray Absorptiometry (DXA) (and by different DXA techniques) have been used to diagnose osteopenia and osteoporosis; and what is the evidence regarding the relationship between differing definitions and the development of osteoporotic fractures?
Osteoporosis In Men
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Author : Eric S. Orwoll
language : en
Publisher: Academic Press
Release Date : 2009-11-30
Osteoporosis In Men written by Eric S. Orwoll and has been published by Academic Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2009-11-30 with Medical categories.
Since the publication of the first edition, the U.S. Surgeon General released the first-ever report on bone health and osteoporosis in October 2004. This report focuses even more attention on the devastating impact osteoporosis has on millions of lives. According to the National Osteoporosis Foundation, 2 million American men have osteoporosis, and another 12 million are at risk for this disease. Yet despite the large number of men affected, the lack of awareness by doctors and their patients puts men at a higher risk that the condition may go undiagnosed and untreated. It is estimated that one-fifth to one-third of all hip fractures occur in men. This second edition brings on board John Bilezikian and Dirk Vanderschueren as editors with Eric Orwoll. The table of contents is more than doubling with 58 planned chapters. The format is larger – 8.5 x 11. This edition of Osteoporosis in Men brings together even more eminent investigators and clinicians to interpret developments in this growing field, and describe state-of-the-art research as well as practical approaches to diagnosis, prevention and therapy. Brings together more eminent investigators and clinicians to interpret developments in this growing field Describes state-of-the-art research as well as practical approaches to diagnosis, prevention and therapy There is no book on the market that covers osteoporosis in men as comprehensively as this book
Osteoporosis Screening Rates In Men With Risk Factors
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Author : Nicole Jones
language : en
Publisher: ProQuest
Release Date : 2008
Osteoporosis Screening Rates In Men With Risk Factors written by Nicole Jones and has been published by ProQuest this book supported file pdf, txt, epub, kindle and other format this book has been release on 2008 with Dissertations, Academic categories.
Screening Men For Osteoporosis
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Author :
language : en
Publisher:
Release Date : 2007
Screening Men For Osteoporosis written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2007 with Men categories.
BACKGROUND: Although 25% of men over the age of 60 will sustain osteoporotic fractures during their lifetime, data suggest that male osteoporosis is underdiganosed [sic] and undertreated. In order to help inform decisions about whether the Veterans Health Administration should develop screening guidelines for male osteoporosis, summaries of what is known about (1) the epidemiology of male osteoporosis, and (2) the validity of tools to screen and diagnose male osteoporosis are needed. The Key Questions were: Key Question 1. What are the prevalence of and risk factors for osteopenia, osteoporosis and osteoporotic fractures among men in general and among male Veterans specifically? Key Question 2. Are there any validated tools (outside of central bone density) to screen for osteoporosis in men? Key Question 3. What values of BMD determined by Dual energy X-ray Absorptiometry (DXA) (and by different DXA techniques) have been used to diagnose osteopenia and osteoporosis; and what is the evidence regarding the relationship between differing definitions and the development of osteoporotic fractures? METHODS: We searched PubMed from 1990-2006 using standard search terms. Titles, abstracts, and articles were reviewed in duplicate by physicians trained in the critical analysis of literature. Data were extracted by quantitative analysts. Pooled analyses were performed for the comparison of either calcaneal ultrasound or the Osteoporosis Screening Tool compared to central DXA; all other data were narratively summarized. RESULTS: We screened 564 titles and performed a more detailed review on 378 articles. From this, we identified 173 articles that addressed risk factors for osteoporosis, 27 articles that addressed diagnostic tools, and 31 articles about differing DXA levels and fracture risk. We identified an older high quality meta-analysis of risk factors for osteoporosis. Of the risk factors assessed in this review that the authors classified as something other than high risk, VA policymakers selected alcohol use, diabetes mellitus type II, and spinal cord injury as the factors for assessment in this review.
Screening Men For Osteoporosis
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Author :
language : en
Publisher:
Release Date : 2007
Screening Men For Osteoporosis written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2007 with Men categories.
Screening For Male Osteoporosis
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Author : Nicole Sagalla
language : en
Publisher:
Release Date : 2022
Screening For Male Osteoporosis written by Nicole Sagalla and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2022 with categories.
Osteoporosis is a systemic skeletal disease characterized by low bone mass and deterioration of the fine structures of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Although studied mainly in postmenopausal women, osteoporosis has been recognized as a prevalent disease in men through similar mechanisms (ie, age-related bone loss, hormonal alterations, and other conditions/risk factors associated with bone loss). However, larger bone size, later onset of increased bone resorption, and lower fall risk are protective factors in men leading to a lower lifetime risk of fracture: 53.2% among women versus 20.7% among men. Despite a lower risk of fracture, for unclear reasons, men have higher rates of osteoporotic fracture-related complications and mortality than women.
Osteoporosis In Men
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Author : Eric S. Orwoll
language : en
Publisher: Academic Press
Release Date : 1999
Osteoporosis In Men written by Eric S. Orwoll and has been published by Academic Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 1999 with Medical categories.
Osteoporosis in men is an important clinical problem that has received little attention, both in the medical arena and from the general public. Although the condition affects a higher percentage of women, it is estimated that two million men in the U.S. have osteoporosis, and three million more are at risk. The lack of awareness by doctors and their patients puts men at a higher risk that the condition may go undiagnosed and untreated. Osteoporosis in Men is the first book to explore this issue in depth. This groundbreaking text brings together eminent investigators and clinicians who interpret developments in this emerging field, and describe state-of-the-art research as well as practical approaches to diagnosis, prevention and therapy. It is an essential reference for researchers, students, and clinicians in bone-related disciplines. Key Features * Provides the first complete description of osteoporosis in men--epidemiology, clinical character, basic aspects, and research directions * Discusses appropriate diagnostic, prevention, and treatment options * Covers a wide range of topics, including the economic impact of fractures on health care expenses * Includes a description of the roles of androgen and estrogen in men * Discusses bone mass measurements and their clinical utility * Explores the essential role of gender in the manifestations of osteoporosis. How is this disorder different in men, and how can we learn from these differences?
Screening To Prevent Osteoporotic Fractures
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Author : Meera Viswanathan
language : en
Publisher:
Release Date : 2018
Screening To Prevent Osteoporotic Fractures written by Meera Viswanathan and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2018 with categories.
PURPOSE: To review evidence about screening to prevent osteoporotic fractures for the U.S. Preventive Services Task Force (USPSTF). DATA SOURCES: PubMed, the Cochrane Library, Embase, and trial registries from November 1, 2009, through October 1, 2016, and surveillance of the literature through March 23, 2018; bibliographies from retrieved articles. STUDY SELECTION: Two investigators independently selected studies using a priori inclusion and exclusion criteria. We selected studies with a majority of adults age 40 years or older conducted in countries with a very high human development index. For screening studies, we required that studies include a majority of participants without prevalent low-trauma fractures. For treatment studies, we required that studies include a majority of participants with increased fracture risk. We selected studies of screening tests (fracture risk prediction instruments, bone measurement testing, or a combination of fracture risk prediction instruments and bone measurement testing) that were feasible for primary care settings and available in the United States. We selected studies of treatment approved by the U.S. Food and Drug Administration for synthesis of benefits and harms. We excluded studies of poor quality and of fracture risk prediction instruments without external validation. DATA EXTRACTION: One investigator extracted data and a second checked accuracy. Two reviewers independently rated quality for included studies using predefined criteria. DATA SYNTHESIS: One fair-quality trial demonstrated reduction in hip fractures when comparing screening with no screening (2.6% v 3.5%, Hazard rate [HR] 0.72; 95% confidence interval [CI], 0.59 to 0.89). The study reported no other statistically significant benefits (osteoporotic or clinical fractures, mortality) or harms (anxiety, quality of life). We included 168 articles of fair or good quality; 105 articles assessed screening accuracy and 65 articles assessed benefits and harms of treatment. Using centrally measured dual-energy X-ray absorptiometry (DXA) as the reference standard for identifying osteoporosis, the pooled estimate of accuracy as measured by the area under the curve (AUC) for clinical risk assessment instruments for women ranges from 0.65 to 0.76 and for men from 0.76 to 0.80. AUCs for the accuracy of calcaneal quantitative ultrasound in identifying central DXA--measured osteoporosis for women is 0.77 (95% CI, 0.72 to 0.82, 7 studies) and for men is 0.80 (95% CI, 0.67 to 0.94, 3 studies). The AUCs of machine-based tests, including centrally measured DXA (areal bone mineral density and trabecular bone score) and calcaneal quantitative ultrasound, for predicting fractures ranged from 0.59 to 0.86 (21 studies). The AUCs for instruments predicting fractures, some of which incorporate machine-based tests, have similar accuracy (pooled AUC range for the Fracture Risk Assessment Tool: 0.62 to 0.79; 24 studies). Available but limited evidence in studies including participants with a wide spectrum of baseline bone mineral density from normal to osteoporosis suggests no benefit from repeating a bone measurement test between 4 and 8 years after the initial screen. Evidence from placebo-controlled trials demonstrates the following benefits. For women, the risk of vertebral fractures can be reduced by bisphosphonates, parathyroid hormone, raloxifene, and denosumab by 36 percent to 68 percent. Relative risks (RRs) range from 0.32 (parathyroid hormone or denosumab) to 0.64 (raloxifene). The risk of nonvertebral fractures can be reduced by 16 percent to 20 percent by bisphosphonates and denosumab (RR, 0.84 and 0.80, respectively). The risk of hip fractures can be reduced by 40 percent by denosumab (RR, 0.60). Evidence from bisphosphonates does not demonstrate benefit for hip fractures. Evidence is very limited for men. The risk of morphometric vertebral fractures can be reduced by 67 percent by zoledronic acid (RR, 0.33). No studies demonstrate reductions in risk of clinical vertebral fractures or hip fractures for men. Evidence on variations in effectiveness for subgroups is also limited; a single trial each for five drugs suggests no differences in effectiveness by age, baseline bone mineral density, prior fractures, or a combination of risk factors. Bisphosphonates are not consistently associated with discontinuations, serious adverse events, gastrointestinal events, or cardiovascular events. No included studies reported cases of osteonecrosis of the jaw or atypical femur fracture, although evidence from excluded studies (including active comparisons, case series, and secondary prevention populations) suggests an increased but rare risk of these outcomes. Raloxifene increases the risk of deep vein thrombosis (0.7% vs. 0.3%, RR, 2.14; 95% CI, 0.99 to 4.66; I2=0%, 3 studies, N=5,839) and hot flashes (11.2% vs. 7.6%, RR, 1.42; 95% CI, 1.22 to 1.66; I2=0%, 5 trials; N=6,249) when compared with placebo. LIMITATIONS: The evidence is limited on the direct question of the benefits and harms of screening for elevated osteoporotic fracture risk. The indirect evidence pathway rests on studies evaluating (1) the accuracy of screening approaches in identifying osteoporosis and predicting fractures and (2) the benefits of treatment among those with osteoporosis or at high risk for fractures. Other limitations of the evidence base relate to underlying heterogeneity in baseline risk, prior fractures, prior treatment, and duration of followup. CONCLUSIONS: Evidence from one trial of screening to prevent osteoporotic fractures suggests a reduction in hip fractures. The accuracy of clinical risk assessment tools for identifying osteoporosis or predicting fractures generally ranges from very poor (0.50) to good (0.90). Treatments reduce the risk of vertebral and nonvertebral fractures. Studies do not consistently demonstrate an increased risk of harms for drugs, although studies of raloxifene suggest a trend toward higher risk of deep vein thrombosis. Rare harms, such as osteonecrosis of the jaw and atypical femur fractures were not reported in this body of evidence but they may occur. The evidence is limited for subpopulations characterized by age, sex, baseline bone mineral density, and baseline fracture risk.
Effectiveness And Costs Of Osteoporosis Screening And Hormone Replacement Therapy
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Author : Office of Technology Assessment
language : en
Publisher:
Release Date : 1995
Effectiveness And Costs Of Osteoporosis Screening And Hormone Replacement Therapy written by Office of Technology Assessment and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1995 with categories.
Bone Health And Osteoporosis
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Author : United States Public Health Service
language : en
Publisher:
Release Date : 2004-12
Bone Health And Osteoporosis written by United States Public Health Service and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2004-12 with Health & Fitness categories.
This first-ever Surgeon General's Report on bone health and osteoporosis illustrates the large burden that bone disease places on our Nation and its citizens. Like other chronic diseases that disproportionately affect the elderly, the prevalence of bone disease and fractures is projected to increase markedly as the population ages. If these predictions come true, bone disease and fractures will have a tremendous negative impact on the future well-being of Americans. But as this report makes clear, they need not come true: by working together we can change the picture of aging in America. Osteoporosis, fractures, and other chronic diseases no longer should be thought of as an inevitable part of growing old. By focusing on prevention and lifestyle changes, including physical activity and nutrition, as well as early diagnosis and appropriate treatment, Americans can avoid much of the damaging impact of bone disease and other chronic diseases. This Surgeon General's Report brings together for the first time the scientific evidence related to the prevention, assessment, diagnosis, and treatment of bone disease. More importantly, it provides a framework for moving forward. The report will be another effective tool in educating Americans about how they can promote bone health throughout their lives. This first-ever Surgeon General's Report on bone health and osteoporosis provides much needed information on bone health, an often overlooked aspect of physical health. This report follows in the tradition of previous Surgeon Generals' reports by identifying the relevant scientific data, rigorously evaluating and summarizing the evidence, and determining conclusions.