Testing is recommended for men at increased risk.
The American College of Physicians (ACP) has issued a clinical practice guideline on screening for osteoporosis in men. The guideline is based on a systematic evidence review of 269 studies that examined risk factors and 20 that examined diagnostic tests. Although often viewed as a problem primarily of women, osteoporosis is prevalent among U.S. men (affecting 7% of white men), underdiagnosed, and often untreated.
The review identified moderate- to high-quality evidence that the following risk factors are associated with low bone-mineral density (BMD) and osteoporotic fractures in men:
Other identified risk factors with low-to-moderate quality evidence were smoking, spinal cord injury, and alcohol use.
The ACP recommends periodic assessment of risk factors in older men and screening with dual energy x-ray absorptiometry (DXA) for men who are at increased risk and are candidates for drug therapy.
Comment: This recommendation is based on evidence that is limited primarily by the study’s focus on BMD and not fractures. I am surprised by the recommendation for screening because the review did not include studies that evaluated treatments to reduce fracture risk among men with risk factors who were identified as having osteoporosis when screened by DXA. In its recommendations for screening of women, the U.S. Preventive Services Task Force provided evidence of treatment benefit in asymptomatic women; the task force has not issued a guideline that addresses men, but I would be interested in its "take" on this topic.
— Richard Saitz, MD, MPH, FACP, FASAM
Published in Journal Watch General Medicine June 12, 2008
Qaseem A et al. Screening for osteoporosis in men: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2008 May 6; 148:680.