POS0319 MALE OSTEOPOROSIS AND SCREENING GUIDELINES: AN UNDERESTIMATED DISEASE IN AGING POPULATION
Authors: M. Martin, A. DI Nisio, A. Ferlin, C. Foresta
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Osteoporosis (OP) is as a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of the bone tissue, leading to bone fragility and fracture susceptibility[1]. It represents a major cause of fractures in individuals over the age of 50 years potentially leading to complex sequelae and increased mortality. OP is widely considered to be much more prevalent in women, even though approximately 39% of new osteoporotic fractures estimated to have occurred worldwide in the year 2000 were in men[1]. The prevalence of OP in the US has been estimated in 3–6% in men &gt;50 years and in 13–18% in women &gt;50 years[2]. However, a study showed a comparable prevalence of osteoporosis for men aged 70 years or older and women aged 65 years[3]. Male OP is clearly underestimated, under-diagnosed and under-treated. The diagnosis is often made late in the natural history of the pathology or even after a fracture event. While guidelines on screening politics do not agree whether and when men should be considered, clinical evidence indicates that men tend to have more OP-related complications and higher mortality rate. <h3>Objectives:</h3> At present, there is no universally accepted policy for screening of male population to identify individuals with OP or those at high risk of fracture. To this end, the aim of this study was to provide a screening of male OP in a random population of aging men, independently of risk factors suggested by international guidelines, to provide real-life data on the actual fracture risk in aging men who wouldn't be otherwise evaluated for bone loss on the basis of clinical guidelines. <h3>Methods:</h3> The study was approved by the Hospital EC (no. 3389/U16/14), and each participant (age &gt;60 y o) gave written informed consent. A standardized questionnaire was used to collect information about smoking habits, alcohol misuse, and calcium intake. Exclusion criteria were any medical disorder or medications known to affect calcium metabolism, and testosterone replacement therapy. Vitamin D and testosterone were evaluated by chemiluminescence methods. Bone density was evaluated at lumbar vertebrae and proximal femur by Radiofrequency Echographic Multi-Spectrometry (REMS), based on the analysis of ultrasound signal backscattering. Subsequently a subgroup of patients underwent also femoral and lumbar DEXA and Heel quantitative ultrasound (QUS) scan. <h3>Results:</h3> A total of 300 male patients were enrolled and performed REMS scans. The prevalence of biochemical hypogonadism and vitamin D insufficiency were 18% and 85% respectively. Subjects were grouped on the basis of their REMS T-score: 61% had a T-score &gt; −1, whereas 28% had osteopenia and 11% had OP. The frequencies of low testosterone and vitamin D insufficiency were significantly higher in patients with osteopenia or OP (22% and 100%) than in healthy subjects (15% and 76%; p = 0.029 and p = 0.013 respectively). Calcium intake and the frequency of smokers did not differ between groups. A subgroup of 80 patients, who were eligible, also underwent DEXA examination; showed concordance between DEXA and REMS in 90% of cases. The same subgroup had also performed a QUS scan, showing a 85% concordance with DEXA, as compared to REMS. <h3>Conclusion:</h3> Based on clinical experience, published guidelines and epidemiology of secondary causes and risk factor for OP in men[4-6], we suggest that OP should be considered in all men when risk factors for low BMD and fractures are present, independently from age. Age per se is sufficient for screening after the age of 60 years. Indeed, if clinicians just better consider bone health in their male patients bearing in mind different conditions, risk factors, lifestyle behaviours, and drugs able to deteriorate bone mass and quality, OP in men could be less ignored than in the past. In addition, non-ionizing approaches such as REMS should be advised for large screenings, given the lack of exposure to radiations, wide availability, lower costs and portability. <h3>REFERENCES:</h3> [1] DOI: 10.1016/0002-9343(93)90218-e. [2] DOI: 10.1359/jbmr.1997.12.11.1761. [3] DOI: 10.1007/s11657-012-0113-0. [4] DOI: 10.1080/14656566.2018.1428559. [5] DOI: 10.1016/S0140-6736(18)32112-3. [6] DOI: 10.1038/nrendo.2013.171. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>