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Bone Tests Cost-Effective for Elderly Men

Younger men with prior fracture could also benefit, study finds

TUESDAY, Aug. 7, 2007 (HealthDay News) -- Bone-density tests for osteoporosis are routine for older women, but a new study finds they might be cost-effective for certain groups of men over 65, too.

One of the first quality assessments of the screenings' costs and benefits for males finds that all men over 80 could benefit from a test, as well as men aged 65 or older who've already suffered a bone fracture.

"The amount of money that you have to spend, compared to the quality of life that you save, is a reasonably good deal for society for these subsets of men," said lead researcher Dr. John Schousboe, of Park Nicollet Health Services in Minneapolis.

His team published its findings in the Aug. 8 issue of the Journal of the American Medical Association.

Experts say the American public has long misconceived of osteoporosis as only a threat to women.

"The current data indicate that one in four Caucasian men will suffer an osteoporosis-related fracture at some point in his lifetime, compared to about one in two women," said Dr. Felicia Cosman, associate professor of medicine at Columbia University, and an osteoporosis specialist at Helen Hayes Hospital in West Haverstraw, N.Y.

"So, it's half as common [in men], but obviously it's still very common," said Cosman, who was not involved in the study.

She noted that fracture is not only disabling for older Americans, it can be deadly. "We know that up to 20 percent of people will actually die in the year following their hip fracture," Cosman said. "That's due to a combination of factors related to the surgery, related to immobilization of being in the hospital, of acute complications of the fracture itself -- pulmonary embolism, for example."

In fact, men are more likely to die from fracture-linked complications than women, experts say. And yet no major medical association has come out and advocated regular bone-density testing for older men. "The U.S. Preventative Services Task Force and its counterpart in Canada have been very silent on this -- they have just not seen the kind of data that would persuade them," Schousboe said.

His team's study is a step toward providing that data. Drawing on existing information on men's bone health, the researchers used a computer simulation to estimate the lifetime cost and benefit of bone-density testing, plus five years of follow-up drug therapy (if warranted), for white men 65, 70, 75, 80 and 85 years of age, with or without a prior history of fractures.

Testing showed that rates of neck-bone osteoporosis in men rose along with age -- from 14.5 percent of men at age 65 to nearly 34 percent at 85 years of age. Men with osteoporosis were also much more likely to end up with a fracture than those without the bone-wasting condition, the researchers found.

Getting a bone-density test, then following it up with drug treatment, did cut down significantly on men's fracture incidence, the study found.

Still, the bone tests were not found to be cost-effective for the full cohort of men over 65, especially for those with no prior history of fracture, the researchers reported.

The approach did reap rewards for two subgroups, however -- men over 80, and men over 65 with a prior history of fracture.

"An example that would be of similar cost-effectiveness would be treating mild-to-moderate hypertension with generic antihypertensive drugs," Schousboe said.

The cost of the osteoporosis test -- estimated to be $82 -- and drug therapy for at-risk men "is offset by some degree by the cost in fractures or treatment of fractures that you save," he explained.

Schousboe hopes the information will spark debate among experts on the virtues of recommending bone scans for older men. "We feel this is a good first step," he said.

For her part, Cosman agreed that men, as well as women, need to take better care of their bones.

"The advice is very similar to what we give to women," she said. Smoking and excessive drinking can harm bones, so giving up those two habits is a great first step, she said. "We also want to concentrate on the best nutrition for bone health -- that includes lots of fruits and vegetables, adequate protein, and of course a calcium- and vitamin D-rich diet."

Exercise -- both weight-bearing and balance-enhancing -- is also key to strengthening aging bones and avoiding dangerous falls, Cosman added. "All of these factors will reduce the likelihood of suffering from an osteoporosis-related fracture," she said.

More information

There's more on bone health at the U.S. Centers for Disease Control and Prevention.

SOURCES: Felicia Cosman, M.D., associate professor, medicine, Columbia University, New York City, and osteoporosis specialist and director, Clinical Research Center, Helen Hayes Hospital, West Haverstraw, N.Y.; John Schousboe, M.D., Park Nicollet Health Services, Minneappolis; Aug. 8, 2007, Journal of the American Medical Association
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