Research opens door to screening some elderly men for osteoporosis

Demand for bone densitometers has dropped in recent years, the consequence of site saturation, technological advances to boost capacity, and declining reimbursements. Not surprisingly, sales revenues for these devices have dropped precipitously, as indicated by Hologic's performance last quarter. The company reported a 20% revenue drop to $15,731,000 in the third quarter from the year-earlier period.

Increased demand for bone densitometry could turn this market around. Good news on this front arrived with the Aug. 8 issue of JAMA in which researchers from the Park Nicollet Health Services in Minneapolis conclude that osteoporosis screening and treatment may be cost-effective for some men.

The researchers note that osteoporotic fractures are a common and serious health problem among elderly men, who account for one-third of all hip fractures. Men face rates of illness and increased risk of death from fractures similar to those in women.

Screening a selected population of older men for osteoporosis and then treating those found to have the disease with oral bisphosphonate therapy to strengthen bone would be cost-effective, according to Dr. John T. Schousboe, a consultant in the rheumatology department of Park Nicollet.

Schousboe and colleagues report that this subpopulation includes men aged 65 years or older who have osteoporosis and have experienced a prior clinical fracture. It also includes men aged 80 years or older without a prior fracture.

This strategy of screening and treatment also may be cost-effective for white men aged 70 years or older who have not had a prior clinical fracture, if the cost of oral bisphosphonate therapy is less than $500 per year, according to the researchers.

To draw their conclusions, the researchers estimated the lifetime costs and health benefits of bone densitometry followed by five years of oral bisphosphonate therapy. They created a computer simulation model for hypothetical groups of white men aged 65, 70, 75, 80, or 85 years, with or without prior clinical fracture. Data from several sources were used to estimate fracture costs and population-based age-specific fracture rates, as well as associations among prior fractures, bone density, and incident fractures.

The researchers estimated that the prevalence of femoral neck osteoporosis among men with a prior fracture ranged from 14.5% at age 65 years to 33.6% at age 85 years. Osteoporosis prevalence in the absence of a prior clinical fracture was lower, ranging from 7.6% at age 65 years to 17.6% at age 85 years.

Diagnosis with bone densitometry and patient treatment modestly reduced the absolute 10-year incidence of clinical fractures by a range of 2.1% for 65-year-old men without a prior fracture to 4.5% among 85-year-old men with a prior fracture.

Because of the modest reductions, universal bone densitometry followed by oral bisphosphonate therapy would not be cost-effective for all men aged 70 years or older regardless of fracture history or other fracture risk factors, Schousboe said.