Are Men at High Risk for Osteoporosis Underscreened? A Quality Improvement Project

Jain, Samta; Bilori, Bilori; Gupta, Amit; Spanos, Pete; Singh, Mamta

doi:10.7812/tpp/14-190

Cited by 18 publications

(8 citation statements)

References 12 publications

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“…Fewer good-quality trials of osteoporosis treatment have been conducted in men compared to women, and trials focused on male participants are less likely to have a preventive purpose [2,3]. Male patients and primary care physicians appear to have low awareness of male osteoporosis [4], with typically low rates of bone mineral density (BMD) testing [5]. In the US, Medicare insurance only covers BMD testing in men for a limited number of disease conditions, not including routine screening [6].…”

Section: Introductionmentioning

confidence: 99%

Comparison of fracture risk assessment tools in older men without prior hip or spine fracture: the MrOS study

et al. 2017

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Purpose We compared the performance of fracture risk assessment tools in older men, accounting for competing risks including mortality. Methods A comparative ROC curve analysis assessed the ability of the QFracture, FRAX® and Garvan fracture risk tools, and femoral neck bone mineral density (BMD) T-score with or without age to identify incident fracture in community-dwelling men aged 65 years or older (N=4994) without hip or clinical vertebral fracture or antifracture treatment at baseline. Results Among risk tools calculated with BMD, the discriminative ability to identify men with incident hip fracture was similar for FRAX (AUC 0.77, 95% CI 0.73, 0.81), the Garvan tool (AUC 0.78, 95% CI 0.74, 0.82), age plus femoral neck BMD T-score (AUC 0.79, 95% CI 0.75, 0.83) and femoral neck BMD T-score alone (AUC 0.76, 95% CI 0.72, 0.81). Among risk tools calculated without BMD, the discriminative ability to identify hip fracture was similar for QFracture (AUC 0.69, 95% CI 0.66, 0.73), FRAX (AUC 0.70, 95% CI 0.66, 0.73) and the Garvan tool (AUC 0.71, 95% CI 0.67, 0.74). Correlated ROC curve analyses revealed better diagnostic accuracy for risk scores calculated with BMD compared to QFracture (p < 0.0001). Calibration was good for the internally generated BMD T-score predictor with or without age and poor for the externally developed risk tools. Conclusion In untreated older men without fragility fractures at baseline, an age plus femoral neck BMD T-score classifier identified men with incident hip fracture as accurately as more complicated fracture risk scores.

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Section: Introductionmentioning

confidence: 99%

Comparison of fracture risk assessment tools in older men without prior hip or spine fracture: the MrOS study

et al. 2017

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“…Causes of this are unclear, but possibly a sense of responsibility from the physician can lead to persistent patient care at times when it is no longer indicated. Further study is warranted in order to explore how the development of targeted investigations, such as earlier palliative care consultation [ 29 – 31 ], may benefit these patients and reduce ICU costs.…”

Section: Discussionmentioning

confidence: 99%

Characteristics, Outcomes, and Cost Patterns of High-Cost Patients in the Intensive Care Unit

Reardon

Fernando

Katwyk

et al. 2018

Critical Care Research and Practice

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Background ICU care is costly, and there is a large variation in cost among patients. Methods This is an observational study conducted at two ICUs in an academic centre. We compared the demographics, clinical data, and outcomes of the highest decile of patients by total costs, to the rest of the population. Results A total of 7,849 patients were included. The high-cost group had a longer median ICU length of stay (26 versus 4 days, P < 0.001) and amounted to 49% of total costs. In-hospital mortality was lower in the high-cost group (21.1% versus 28.4%, P < 0.001). Fewer high-cost patients were discharged home (23.9% versus 45.2%, P < 0.001), and a large proportion were transferred to long-term care (35.1% versus 12.1%, P < 0.001). Patients with younger age or a diagnosis of subarachnoid hemorrhage, acute respiratory failure, or complications of procedures were more likely to be high cost. Conclusions High-cost users utilized half of the total costs. While cost is associated with LOS, other drivers include younger age or admission for respiratory failure, subarachnoid hemorrhage, or after a procedural complication. Cost-reduction interventions should incorporate strategies to optimize critical care use among these patients.

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“…Osteoporosis in men is widely understudied, despite the fact that one third of all hip fractures worldwide occur in men [ 31 ] and that mortality in men during the first year after hip fracture is 51% higher than in women [ 32 ]. Additionally, the effect of aspirin usage on bone health has not been widely studied, though some studies have found it to be associated with higher BMD in both men and women [ 33 ].…”

Section: Introductionmentioning

confidence: 99%

Anti-atherogenic properties of vitamin E, aspirin, and their combination

Chai

Arjmandi

2018

PLoS ONE

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The present study was designed to assess the extent to which vitamin E and aspirin individually or in combination prevent and/or reverse bone loss and atherosclerotic lesion formation in orchidectomized aged rats. Forty-nine 12-month old male Sprague-Dawley rats were either sham-operated (Sham, one group) or orchidectomized (Orx, four groups) and fed a control diet for 120 days to establish bone loss and atherosclerotic lesions. Thereafter, rats were assigned to the various treatment groups (n = 9 to 10 per group): 1) Sham and 2) Orx groups received AIN93M, containing 75 IU vitamin E and served as control, and the other three Orx groups received either 3) 500 IU vitamin E, 4) 500 mg aspirin, or 5) 500 IU vitamin E + 500 mg aspirin per kg diet for 90 days. After 90 days of treatment, rats were sacrificed, necropsied, and tissues were collected for analyses. Results show that 500 IU vitamin E was able to reduce the development of atherosclerosis lesion formation and aortic streak area compared to Orx control. More importantly, 500 mg aspirin completely reversed the fatty streak area and made the atherosclerotic lesions disappear. Vitamin E and aspirin were not able to reverse bone loss as shown by whole body, lumbar and femoral bone mineral content and bone mineral density due to gonadal hormone deficiency. Instead, 500 mg aspirin somewhat increased the trabecular separation while decreased trabecular thickness compared to Orx control. Our findings suggest that both, vitamin E and aspirin exert anti-atherogenic effects and aspirin is more effective than vitamin E in preventing atherosclerosis lesions in Orx rats.

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Are Men at High Risk for Osteoporosis Underscreened? A Quality Improvement Project

Cited by 18 publications

References 12 publications

Comparison of fracture risk assessment tools in older men without prior hip or spine fracture: the MrOS study

Comparison of fracture risk assessment tools in older men without prior hip or spine fracture: the MrOS study

Characteristics, Outcomes, and Cost Patterns of High-Cost Patients in the Intensive Care Unit

Anti-atherogenic properties of vitamin E, aspirin, and their combination

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