Osteoporosis Screening in Men: USPSTF Guidelines vs Real-World Data

Abstract

Introduction: Osteoporosis screening in men is controversial. USPSTF gives an I (insufficient evidence) statement, yet men account for 25% of osteoporotic fractures. Methods: Retrospective cohort of 5,402 men ≥65 years undergoing DEXA screening in primary care. Outcomes: prevalence of osteopenia (T-score -1.0 to -2.4) and osteoporosis (T-score ≤ -2.5), plus 5-year major osteoporotic fracture (MOF) risk (FRAX). Results: Osteoporosis prevalence was 8.4% (95% CI 7.7-9.1%), osteopenia 41.3%. Among men with no clinical risk factors, osteoporosis was still 3.2%. MOF risk was 11.2% in osteoporotic men. Only 22% of men with T-score ≤ -2.5 received pharmacotherapy (bisphosphonates) within 1 year. Discussion: Osteoporosis is not rare in older men, yet underdiagnosis and undertreatment are substantial. Risk factors (low BMI, smoking, glucocorticoids) alone miss one-third of cases. Conclusion: Universal DEXA screening for men ≥70 years may be justified. Randomized trials are needed.