Gender differences in osteoporosis and fractures.
BACKGROUND
Osteoporosis is generally thought of as a "woman's disease" because the prevalence of osteoporosis and the rate of fractures are much higher in postmenopausal women than in older men. However, the absolute number of men affected by osteoporosis and fractures is large, as at least 2.8 million men in the United States are thought to have osteoporosis.


OBJECTIVE
The purposes of this review are to (1) highlight gender differences in osteoporosis and fracture risk, (2) describe disparities in treatment and outcomes after fractures between men and women, and (3) propose solutions to reducing disparities in treatment and prevention.


METHODS
A literature survey was conducted using MEDLINE with a variety of search terms and using references from the author's personal collection of articles. A formal search strategy and exclusion criteria were not employed and the review is therefore selective. WHERE ARE WE NOW?: Postmenopausal women have a higher prevalence of osteoporosis and greater incidence of fracture than older men. Despite the higher fracture risk in postmenopausal women, older men tend to have worse outcomes after fracture and poorer treatment rates, although less is known about the disease course in men. Multifaceted interventions to improve the screening and treatment for osteoporosis were recently developed. WHERE DO WE NEED TO GO?: Improvement in treatment rates of those at risk, regardless of gender, is an important goal in osteoporosis management. HOW DO WE GET THERE?: Further development and evaluation of cost-effective, multifaceted interventions for screening and treatment of osteoporosis and fractures are needed; such interventions will likely improve the primary prevention of fractures.
San Francisco Coordinating Center, California Pacific Medical Center Research Institute, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107-1762, USA. pcawthon@sfcc-cpmc.net
Peggy M
PM
Cawthon
D015519:Bone Density / Q000502:physiology; D005260:Female; D005598:Fractures, Spontaneous / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008403:Mass Screening; D008571:Men; D010024:Osteoporosis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011287:Prejudice; D012307:Risk Factors; D012727:Sex Characteristics; D012737:Sex Factors; D016896:Treatment Outcome; D014930:Women; D016387:Women's Health
J Clin Densitom. 2002 Spring;5(1):87-93
11940733
J Bone Miner Res. 2005 Jul;20(7):1185-94
15940371
JAMA. 1999 Oct 13;282(14):1344-52
10527181
J Am Acad Nurse Pract. 2010 Jun;22(6):326-9
20536631
J Gerontol A Biol Sci Med Sci. 2006 May;61(5):495-9
16720747
Ann Intern Med. 2010 Mar 16;152(6):380-90
20231569
J Bone Miner Res. 2007 Mar;22(3):465-75
17144789
Am J Epidemiol. 1996 Nov 1;144(9):901-7
8890668
J Bone Joint Surg Am. 2009 Nov;91 Suppl 6:79-86
19884415
J Bone Miner Res. 2004 Dec;19(12):1945-54
15537436
Osteoporos Int. 1998;8(5):468-89
9850356
J Clin Densitom. 2008 Jan-Mar;11(1):75-91
18442754
Osteoporos Int. 2011 Jan;22(1):249-54
20229198
Bone. 2004 Jan;34(1):195-202
14751578
Osteoporos Int. 1991 Sep;1(4):232-41
1790410
J Bone Joint Surg Am. 2006 Jan;88(1):25-34
16391246
J Bone Miner Res. 2005 Nov;20(11):1921-8
16234964
Osteoporos Int. 2005 Feb;16(2):115-27
15517187
N Engl J Med. 2010 Feb 25;362(8):686-96
20181970
Arch Intern Med. 2002 Oct 28;162(19):2217-22
12390065
J Am Geriatr Soc. 2005 Oct;53(10):1697-704
16181168
N Engl J Med. 2000 Aug 31;343(9):604-10
10979796
N Engl J Med. 2007 May 3;356(18):1809-22
17476007
Bone. 2006 Sep;39(3):644-51
16790372
Arch Intern Med. 2007 Oct 22;167(19):2110-5
17954806
N Engl J Med. 2001 Feb 1;344(5):333-40
11172164
J Bone Joint Surg Am. 2006 Jan;88(1):18-24
16391245
J Bone Miner Res. 2007 Jun;22(6):781-8
17352657
N Engl J Med. 2009 Aug 20;361(8):756-65
19671655
J Gerontol A Biol Sci Med Sci. 2007 Aug;62(8):872-8
17702879
J Bone Miner Res. 2002 Apr;17(4):716-24
11918229
J Bone Miner Res. 2006 Oct;21(10):1550-6
16995809
Osteoporos Int. 2005 Aug;16(8):953-62
15928798
CMAJ. 2008 Feb 26;178(5):569-75
18299546
J Am Geriatr Soc. 2010 Apr;58(4):650-7
20398147
JAMA. 1998 Dec 23-30;280(24):2077-82
9875874
J Bone Miner Res. 2007 Jan;22(1):135-41
17042717