Secondary Analyses of Osteoporosis Screening in Older Men

描述（由申请人提供）：在美国，男性占骨折的29%，占骨折相关费用的25%。虽然男性骨折发生率低于女性，但男性特别感兴趣，因为他们更有可能在髋部骨折后1年内死亡。 骨矿物质密度（BMD）测试，以确定和治疗骨质疏松症（非常低的BMD）已被提出作为一种方法，以防止致残性骨折的老年男性，主要是因为这是一个公认的筛选策略，在妇女年龄65岁及以上。然而，男性BMD筛查的有效性尚不确定。由于骨质疏松症筛查的随机对照试验被认为是不可行的，因此需要进行观察性研究来测试如何使用BMD筛查来识别骨折高风险的老年男性，并评估其他（非骨折相关）原因导致的死亡是否会降低男性中“最年长者”发生髋关节或临床椎骨骨折的风险。风险因素评估也应该进行研究，因为临床实践指南建议风险评估，以指导选择男性进行BMD筛查。 我们的长期目标是确定一个高风险的老年男性群体，他们应该进行常规的BMD筛查和风险因素评估，以选择减少严重骨折的药物候选人。我们假设，在65岁及以上的男性中，首次髋部或临床椎骨骨折的相对发生率与其他原因死亡的发生率将在考虑进行BMD筛查时的最佳年龄范围内达到峰值，随后随着年龄的增加，BMD筛查的益处逐渐减少。我们进一步假设，临床危险因素将预测事件髋关节或临床椎骨骨折准确的骨密度在老年男性。我们计划对男性骨质疏松性骨折研究（MrOS）的数据进行分析，为老年男性高危人群提供选择性BMD筛查策略，适应男性骨折的临床风险因素和随着年龄增长其他原因死亡率越来越高。 该项目的具体目标：1）根据年龄组，比较老年男性首次髋部或临床椎骨骨折的时间与其他原因死亡的时间; 2）比较基线BMD T评分较低与较高的老年男性首次髋部或临床椎骨骨折的时间; 3）评估骨折风险评估评分的准确性，无BMD和有BMD预测老年男性髋部或主要骨质疏松性骨折。 影响：这些目标的成功完成将证明，在老年男性的高风险组中进行BMD筛查将预测大量的严重骨折病例，并将测试风险因素评估是否是男性BMD筛查的有力辅助手段。这些发现将为男性骨折预防指南提供比目前基于专家意见的指南更强有力的证据基础。

DESCRIPTION (provided by applicant): Men account for 29% of fractures and 25% of fracture-related costs in the US. Although fewer fractures occur in men compared to women, men are of special interest because they are more likely to die within 1 year after a hip fracture. Bone mineral density (BMD) testing to identify and treat osteoporosis (very low BMD) has been proposed as a method to prevent disabling fractures in older men, largely because this is an accepted screening strategy in women aged 65 years and older. However, the efficacy of BMD screening in men is uncertain. Because an RCT of osteoporosis screening is not considered feasible, observational studies are needed to test how BMD screening should be used for identification of older men at high risk of fracture, and to assess whether death from other (non-fracture-related) causes overwhelms the risk of incident hip or clinical vertebral fracture in the "oldest old" of men. Risk factor assessment should also be studied because clinical practice guidelines recommend risk assessment to guide the selection of men for BMD screening. Our long-term goal is to identify a high-risk group of older men that should have routine BMD screening and risk factor assessment to select candidates for medications to reduce major fractures. We hypothesize that in men aged 65 and older, the relative incidence of first hip or clinical vertebral fracture vs. incidence of other-cause death will peak within an optimal age range when BMD screening could be considered, with subsequent decreasing benefit from BMD screening with increasing age. We further hypothesize that clinical risk factors will predict incident hip or clinical vertebral fracture as accurately as BMD in older men. Our planned analyses of data from the Osteoporotic Fractures in Men Study (MrOS) will inform a selective BMD screening strategy for a high-risk group of older men, accommodating men's clinical risk factors for fracture and increasingly higher rate of other-cause death with advancing age. Specific aims of this project: 1) Compare the time to first hip or clinical vertebral fracture vs. ime to other-cause death according to age group in older men; 2) Compare the time to first hip or clinical vertebral fracture in older men with lower vs. higher baseline BMD T-scores; 3) Estimate the accuracy of fracture risk assessment scores without and with BMD to predict hip or major osteoporotic fracture in older men. Impact: Successful completion of these aims will demonstrate that BMD screening in a high-risk group of older men will predict significant numbers of major fracture cases, and will test whether risk factor assessment is a strong adjunct to BMD screening in men. These findings would provide a stronger evidence base for men's fracture prevention guidelines than those currently based on expert opinion.