OP0112 FACTORS ASSOCIATED WITH OSTEOPOROSIS CARE OF MEN: A REAL-LIFE STUDY ON A NATION-WIDE DATASET
Authors: Adami G. , Gatti D. , Giollo A. , Bertoldo E. , Viapiana O. , Olivi P. , Fassio A. , Rossini M. 
Published: May 2021

Background:

Male osteoporosis is associated with an important clinical and economic burden worldwide. Notwithstanding that, undertreatment of men with osteoporosis is common. Understanding the factors associated with less osteoporosis care utilization might help define future intervention to improve access of men to osteoporosis care.

Objectives:

The aim of the study was to describe the factors associated with osteoporosis care in men.

Methods:

We conducted a retrospective analysis of a nation-wide cohort (DeFRACalc79 database). DeFRACalc79 is a tool that estimates the fracture risk considering clinical and densitometric risk factors, including the presence of prior hip or vertebral and non-vertebral or non-hip fractures. We compared the clinical characteristics of male individuals with an age matched cohort of women. Propensity score generation with 2:1 matching for female and male patients was performed matching the cohorts for age, generating propensity estimates with a logistic regression model.

Results:

We analyzed a sample of 4,902 men at high risk of osteoporosis. We found that the factors associated to osteoporosis care utilization in men were: the presence of comorbidities (OR 1.939, 95% CI 1.799-2.090), adjuvant hormonal therapy for prostate cancer (OR 1.482, 95% CI 1.315-1.670), the presence of vertebral or hip fractures (OR 1.490, 95% CI 1.378-1.611) and glucocorticoid treatment (OR 2.573, 95% CI 2.274-2.832) (Table 1)

Table 1.

Clinical and densitometric characteristics of the study population and age-matched cohort of women

Men (n=4,902)Women (n=9,804)OR (95% CI) – p valueAge (±SD)65.1 (±14.2)65.1 (±14.2)NSBMI (±SD)25.31 (±4.91)24.07 (±4.85)<0.0001Lumbar spine T-score (±SD)-2.13 (±1.37)-2.51 (±1.15)<0.0001Osteoporosis at lumbar spine (%)2,601 (53.1%)5,948 (60.7%)0.733 (0.684-0.785)Femoral neck T-score (±SD)-1.93 (±1.04)-2.19 (±0.91)<0.0001Osteoporosis at femoral neck (%)1,412 (28.8%)3,936 (40.1%)0.603 (0.560-0.649)% 10-year risk of fracture (±SD)22.77 (±21.05)20.26 (±4.85)<0.0001Family history of fragility fracture (%)891 (18.2%)2,379 (24.3%)0.693 (0.636-0.756)Secondary osteoporosis (%)2,415 (49.3%)3,092 (31.5%)2.108 (1.965-2.262)Glucocorticoids ≥5 mg/day >3 months (%)768 (17.4%)694 (7.7%)2.573 (2.274-2.832)Glucocorticoids ≥5 mg/day ≥3 months <12 months (%)74 (2.0%)72 (0.9%)2.357 (1.700-3.267)Glucocorticoids ≥5 mg/day ≥12 months (%)119 (3.2%)138 (1.6%)1.977 (1.543-2.534)Adjuvant hormonal therapy for breast cancer or prostate cancer (%)495 (12.0%)766 (8.4%)1.482 (1.315-1.670)Comorbidities (%)1,778 (36.3%)2,225 (22.7%)1.939 (1.799-2.090)Rheumatoid arthritis (%)303 (8.8%)511 (6.3%)1.439 (1.241-1.668)Psoriatic arthritis (%)59 (1.9%)103 (1.3)1.390 (1.006-1.919)Systemic lupus erythematosus (%)22 (0.7%)77 (1.0%)0.693 (0.431-1.115)Systemic sclerosis (%)9 (0.3%)60 (0.8%)0.364 (0.180-0.734)Other rheumatic diseases (%)173 (5.2%)310 (3.9%)1.354 (1.119-1.638)Inflammatory bowel diseases (%)144 (2.7%)126 (1.6%)2.773 (2.175-3.534)Chronic obstructive pulmonary disease (%)281 (8.3%)277 (3.5%)2.461 (2.074-2.920)Diabetes (%)441 (12.4%)478 (5.9%)2.238 (1.954-2.564)Neurological diseases (%)236 (7.0%)260 (3.3%)2.202 (1.837-2.639)HIV infection (%)110 (3.4%)23 (0.3%)11.603 (7.389-18.221)Vertebral or hip fractures (%)1,434 (29.3%)2,130 (21.7%)1.490 (1.378-1.611)Non-vertebral, non-hip fractures (%)534 (10.9%)1,477 (15.1%)0.689 (0.620-0.766)

Conclusion:

We found that men accessed osteoporosis care with more severe osteoporosis and/or with a diagnosis of secondary osteoporosis. Male osteoporosis remains largely underdiagnosed with a dramatic latency in osteoporosis care utilization compared to women.

Disclosure of Interests:

None declared