Screening for osteoporosis in men: a systematic review for an American College of Physicians guideline.
BACKGROUND
Screening for low bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) is the primary way to identify asymptomatic men who might benefit from osteoporosis treatment. Identifying men at risk for low BMD and fracture can help clinicians determine which men should be tested.


OBJECTIVE
To identify which asymptomatic men should receive DXA BMD testing, this systematic review evaluates 1) risk factors for osteoporotic fracture in men that may be mediated through low BMD and 2) the performance of non-DXA tests in identifying men with low BMD.


METHODS
Studies identified through the MEDLINE database (1990 to July 2007).


METHODS
Articles that assessed risk factors for osteoporotic fracture in men or evaluated a non-DXA screening test against a gold standard of DXA.


METHODS
Researchers performed independent dual abstractions for each article, determined performance characteristics of screening tests, and assessed the quality of included articles.


RESULTS
A published meta-analysis of 167 studies evaluating risk factors for low BMD-related fracture in men and women found high-risk factors to be increased age (>70 years), low body weight (body mass index <20 to 25 kg/m2), weight loss (>10%), physical inactivity, prolonged corticosteroid use, and previous osteoporotic fracture. An additional 102 studies assessing 15 other proposed risk factors were reviewed; most had insufficient evidence in men to draw conclusions. Twenty diagnostic study articles were reviewed. At a T-score threshold of -1.0, calcaneal ultrasonography had a sensitivity of 75% and specificity of 66% for identifying DXA-determined osteoporosis (DXA T-score, -2.5). At a risk score threshold of -1, the Osteoporosis Self-Assessment Screening Tool had a sensitivity of 81% and specificity of 68% to identify DXA-determined osteoporosis.


CONCLUSIONS
Data on other screening tests, including radiography, and bone geometry variables, were sparse.


CONCLUSIONS
Key risk factors for low BMD-mediated fracture include increased age, low body weight, weight loss, physical inactivity, prolonged corticosteroid use, previous osteoporotic fracture, and androgen deprivation therapy. Non-DXA tests either are too insensitive or have insufficient data to reach conclusions.
Liu
Hau
H
Santa Clara Valley Medical Center, San Jose, California 95128, USA. hauliu@stanford.edu
Paige
Neil M
NM
Goldzweig
Caroline L
CL
Wong
Elaine
E
Zhou
Annie
A
Suttorp
Marika J
MJ
Munjas
Brett
B
Orwoll
Eric
E
Shekelle
Paul
P
D015502:Absorptiometry, Photon; D035843:Biomedical Research; D015519:Bone Density; D002111:Calcaneus / Q000000981:diagnostic imaging; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012307:Risk Factors; D014463:Ultrasonography