Secondary Analyses of Osteoporosis Screening in Older Men

描述(由申请人提供)：男性占美国骨折的29%，占骨折相关费用的25%。尽管与女性相比，男性骨折较少，但男性尤其令人感兴趣，因为他们更有可能在髋部骨折后一年内死亡。 骨密度(BMD)测试用于识别和治疗骨质疏松症(非常低的BMD)，已被提议作为预防老年男性致残性骨折的一种方法，主要是因为这是65岁及以上女性接受的筛查策略。然而，男性BMD筛查的效果尚不确定。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，以测试如何使用骨密度筛查来识别具有高骨折风险的老年男性，并评估其他(与骨折无关)原因导致的死亡是否压倒了“高龄”男性发生髋部或临床脊椎骨折的风险。风险因素评估也应该研究，因为临床实践指南建议进行风险评估，以指导选择男性进行骨密度筛查。我们的长期目标是确定一组高危老年男性，他们应该进行常规的骨密度筛查和风险因素评估，以选择药物治疗以减少严重骨折。我们假设，在65岁及以上的男性中，首次髋部或临床椎体骨折的相对发生率与其他原因死亡的发生率将在可以考虑骨密度筛查的最佳年龄范围内达到峰值，随后骨密度筛查的益处随着年龄的增加而减少。我们进一步假设，临床危险因素将与老年男性的骨密度一样准确地预测髋部或临床椎体骨折的发生。我们计划对男性骨质疏松性骨折研究(MROS)的数据进行分析，为老年男性的高危人群提供选择性的BMD筛查策略，考虑到男性骨折的临床风险因素，以及随着年龄的增长其他原因死亡率越来越高。该项目的具体目标是：1)比较不同年龄组老年男性首次髋部或临床椎体骨折的时间与其他原因死亡的时间；2)比较基线BMD T评分较低和较高的老年男性首次髋部或临床椎体骨折的时间；3)评估骨折风险评估评分在没有或有BMD的情况下预测老年男性髋部或主要骨质疏松性骨折的准确性。影响：成功完成这些目标将证明，在老年男性高危人群中进行骨密度筛查将预测大量重大骨折病例，并将测试风险因素评估是否是男性骨密度筛查的有力补充。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.