OSTEOPOROSIS Australia (OA) hopes new Australian research, which confirms and quantifies underdiagnosis and undertreatment of osteoporosis in older men, will convince the federal health department to lower the age for free access to bone mineral density tests.

Professor Peter Ebeling, honorary medical director of OA, said the organisation was lobbying the health department to lower the age for free bone mineral density testing from 70 years for men and women, to 60 years for men and menopause for women.

A proposal for the change will be resubmitted to the department by University of Adelaide Visiting Professor Christopher Nordin after an initial submission was recently knocked back on the grounds of insufficient evidence.

Professor Nordin, a medical researcher with an interest in osteoporosis and bone density, has been a strong advocate of early testing to prevent osteoporosis.

An analysis in the Medical Journal of Australia of one of the largest osteoporosis studies in Australia, the Concord Health and Ageing in Men Project (CHAMP), found that despite a high prevalence of osteoporosis in older Australian men, awareness, diagnosis and treatment remain low.(1)

Of 1626 men aged 70 years or over who underwent dual x-ray absorptiometry scans, 25% met one or more of the PBS criteria for osteoporosis treatment, mainly due to asymptomatic vertebral deformities, yet 90% of the men did not know they had osteoporosis.

Only 10% of those eligible for PBS-subsidised treatment reported use of a bisphosphonate, 14% had taken calcium supplements, 7% had taken vitamin D supplements and only 1% had taken all three in combination.

“Obtaining information about previous fractures, identifying vertebral deformities and testing [bone mineral density], where appropriate, can identify men at higher risk of fracture who may benefit from interventions,” the authors said.

Professor Ebeling said the ratio of bone density testing was only one male for every 12 females in rural and remote areas of Australia but the prevalence of osteoporosis was about 1:2.

“It is really bad that we are still not getting the message across that men can get osteoporosis, both at the level of GPs and patients,” Professor Ebeling said.

Men are probably falling through the cracks because they are loath to have health checks, he said.

Another reason to aim for early diagnosis of osteoporosis in men was that 37% died in the first year after a hip fracture compared with about 25% of women, Professor Ebeling said.

Professor Nordin said early testing was important because low bone density should be picked up and treated with lifestyle measures such as calcium, exercise and salt restriction before people actually developed osteoporosis.

“Expensive pharmaceuticals should be restricted to people who have got osteoporosis,” he said.

Med J Aust 2010; 193: 387-391.

 

Posted 5 October 2010

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