Are there differences between men and women prescribed bisphosphonate therapy in canadian subspecialty osteoporosis practices?
OBJECTIVE
To determine if there are differences between men and women referred for treatment of osteoporosis in Canada.


METHODS
We performed an observational study of 1588 patients (163 men, 1425 women), 50 years of age and older, who were prescribed cyclic etidronate or alendronate for treatment of osteoporosis or osteopenia and had at least 2 years of followup registered in the Canadian Database for Osteoporosis and Osteopenia Patients (CANDOO). Comparisons of characteristics between men and women were performed using Pearson chi-square test, Student's t test, or a Kruskal-Wallis test, whichever was most appropriate.


RESULTS
Mean baseline femoral neck and lumbar spine bone mineral densities were significantly higher in men than women at both the femoral neck and lumbar spine (p < 0.05, respectively). Men had double the rate of prevalent vertebral fractures (44%, 72/163) compared to women (22%, 315/1425; p < 0.001) and triple the rate of multiple prevalent vertebral fractures (10%, 17/163) compared to women (3%, 37/1425, p < 0.001). Furthermore, men were twice as likely as women to sustain a fracture within 2 years of starting treatment during observation in the CANDOO study (men: 4%, 7/163, women: 2%, 24/1425, p = 0.033).


CONCLUSIONS
Osteoporosis may be under-recognized in men until the condition is at an advanced stage. A form of gender bias may exist in recognition and treatment (or referral for treatment) of osteoporosis in men.
McMaster University, St. Joseph's Healthcare, Centre for Evaluation of Medicines, Hamilton, Ontario, Canada.
Anna M
AM
Sawka
Jonathan D
JD
Adachi
Alexandra
A
Papaioannou
Lehana
L
Thabane
George
G
Ioannidis
K Shawn
KS
Davison
Wojciech P
WP
Olszynski
Jacques P
JP
Brown
David A
DA
Hanley
Tim M
TM
Murray
Robert G
RG
Josse
Rolf J
RJ
Sebaldt
Annie
A
Petrie
Alan
A
Tenenhouse
Charles H
CH
Goldsmith
D000368:Aged; D019386:Alendronate / Q000627:therapeutic use*; D002170:Canada; D012968:Etidronic Acid / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy*; D011287:Prejudice; D012017:Referral and Consultation; D012737:Sex Factors
D012968:Etidronic Acid; D019386:Alendronate