Commentary: Male Osteoporosis—Policy Gaps in Prevention and Treatment

Outpatient and Home-Based Treatment: Effective Settings for Hip Fracture Rehabilitation in Elderly Patients

Femoral neck fractures are a major source of disability in the elderly. Rehabilitation is fundamental to recover pre-fracture functionality. We conducted an observational cohort study with the aim of comparing the efficacy of rehabilitation programs in different therapeutic settings. We included elderly patients who had undergone surgical stabilization of a hip fracture. The participants were divided into 3 groups: group 1, outpatient rehabilitation; group 2, inpatient rehabilitation; group 3, home-based rehabilitation. Patients were evaluated at baseline, at three months, and at six months after fracture. Our outcome measures were the Barthel Index (BI), Functional Ambulation Categories, passive and active range of motion of hip flexion and abduction, and muscle strength in hip flexion, abduction, and knee extension. At six months, all three groups showed an average statistically significant improvement (p < 0.05) in all outcome measures compared to the baseline. Considering the between-group analysis, final BI was significantly higher in outpatient than inpatient-treated patients (p = 0.018), but no statistical difference was found between outpatient and home-based patients. Our findings suggest that rehabilitation leads to significant functional recovery after hip fracture in elderly patients. Both outpatient and home-based rehabilitation seem to be reasonable options for hip fracture rehabilitation.

Are we closing the gaps in the management of osteoporosis following fragility fractures of the femur?

Objective

The objective of this study was to identify deficiencies in initiating anti-osteoporotic treatment following a fragility femoral fracture.

Methods

All patients ≥55 years of age treated for a fragility femoral fracture between June 2012 and May 2017 were enrolled. Medications at discharge and at 90 days and 1 year of follow up were analyzed. Patients were classified into 4 groups: Group I did not receive any treatment for osteoporosis; Group II received only calcium and vitamin D₃; Group III received an anabolic agent, calcium, and vitamin D₃; and Group IV received bisphosphonates, calcium, and vitamin D₃.

Results

A total of 167 patients with an average age of 65.81±12.55 years were included. There were 88 (52.7%) males and 79 (47.3%) females. At discharge, 107 patients (64.1%) were not prescribed optimal treatment for osteoporosis, and this reduced to 55 (32.9%) at the 90-day follow up. At 1 year, the number of patients receiving suboptimal treatment was further reduced to 25.74%.

Conclusions

Although the number of patients with fragility fractures receiving insufficient treatment was lower in the present study than in previous reports, increased efforts and coordinated treatment plans initiated by a fracture liaison service should be of high priority.

Screening for Male Osteoporosis at an Academic Medical Center

Recent findings suggest that men have higher mortality rates than women after a hip fracture. Although the risk of osteoporotic fractures in men is increasing, male osteoporosis still remains underdiagnosed and undertreated. In general, male osteoporosis is given low priority by policy makers in public health initiatives. The purpose of this study is to examine the patterns of use and gender distribution of DXA (dual-energy X-ray absorptiometry) scan usage at a university medical center in the United States. The total number of DXA scans increased during the study period while the percentage of men studied actually declined. The results of this study may lead to heightened awareness among providers who are caring for male patients at risk for osteoporosis.

The effect of the addition of osteoporosis education to a bone health screening program for older adults

Osteoporosis affects approximately 26% of women and 4% of men after the age of 65 years. However, the diffusion of knowledge about osteoporosis risk factors, prevention and treatment remains low. The purpose of this longitudinal study was to investigate the value of adding initial and refresher osteoporosis education classes to a bone health screening program. A convenience sample of 376 men (n = 62) and women (n = 314) over the age of 62 years was assigned randomly to the Screening plus Education (n =193) or Screening only (n = 183) groups. Participants in both study groups demonstrated an increase in knowledge about osteoporosis, regardless of group assignment and other factors, over the two years of the study. Self-reported calcium use increased for all women and for men in the education group from baseline to year one, with a decline thereafter. There was no effect on exercise behaviors. This study points out the critical need for a more comprehensive and personalized bone health program that includes more than classroom-based education.

Validation of the Male Osteoporosis Knowledge Quiz

The purpose of this study was to validate the six-item Men’s Osteoporosis Knowledge Quiz (MOKQ). The MOKQ asks questions about risk factors that are pertinent to men, such as the risk for developing low bone mass related to hormone treatment for prostate cancer and the importance of testosterone for bone mass. A survey was sent to 242 men with a mean age of 83.2 years. The mean number of questions answered correctly in response to the six-item MOKQ was 2.37. Convergent validity was examined by correlating the score achieved on the MOKQ with the score achieved on the total Facts on Osteoporosis Quiz. The Pearson correlation coefficient for the MOKQ and the Facts on Osteoporosis Quiz was r = .76. Reliability was demonstrated by computing a Cronbach’s alpha for the MOKQ ( r = .72). The MOKQ was found to have adequate reliability and validity in assessing older men’s knowledge about osteoporosis.

Older men's knowledge of osteoporosis and the prevalence of risk factors

It has been estimated that up to 45% of men in the United States have low bone density. Yet, only a few studies have examined men's knowledge of bone health and disease. Men's knowledge of sex-specific issues related to osteoporosis is especially not well understood. We surveyed 1535 community-dwelling men with a mean age of 79 yr. The assessed risk factors included a current diagnosis of low bone mass, positive history for fracture, recent level of physical activity, and current medications with the potential to affect bone health. Knowledge about male risk factors for osteoporosis was also assessed, including the effects of advancing age, frame size, fracture risk, calcium and Vitamin D supplementation, low testosterone level, and treatment for prostate cancer. Within this sample, only 11% of the men reported a current diagnosis of low bone mass, whereas 11% reported a prior hip fracture. Only 5% of the sample reported taking some type of Food and Drug Administration-approved medication for osteoporosis. In the aggregate, the participating men answered only 39% of the 6 male osteoporosis-knowledge questions correctly. It is imperative that bone health promotion campaigns that have educated many women effectively now expand their focus to advance the bone health of men also.