title: High Prevalence of Osteoporosis and Morphometric Vertebral Fractures in Indian Males Aged 60 Years and Above: Should Age for Screening Be Lowered?
abstract: Current guidelines recommend bone mineral density (BMD) measurement in asymptomatic men above age 70 years and vertebral fracture (VF) assessment above 80 years with T-score <-1.0 with risk factors. We studied the prevalence of osteoporosis and morphometric VF in asymptomatic males aged 60 years and above in North India. Free-living community-dwelling men (n = 241, age: mean ± standard deviation 68.0 ± 6.2 years) underwent a detailed history, physical examination, biochemical evaluation, and BMD measurements at 3 sites: lumbar spine, total hip (TH), and femoral neck (FN). Morphometric VF were assessed by instant vertebral assessment using Genant et al's semiquantitative method. We observed osteoporosis, osteopenia, and normal BMD in 19%, 56%, and 25% of subjects, respectively. The decade wise prevalence of osteoporosis in the age groups 60-70 years, 71-80 years, and >80 years was 16.9%, 17%, and 50%, respectively. Mean serum 25OHD levels were 17.2 ± 10.3 ng/mL. Vitamin D deficiency (<20 ng/mL) and secondary hyperparathyroidism (plasma intact parathyroid hormone >65 ng/mL) were present in 68.8% and 45.4%, respectively. VF were present in 29.6% subjects (grade I: 58%, grade II: 32.4%, and grade III: 8.8%). Age and iPTH had significant negative correlation with BMD at FN and TH. Serum 25OHD had no correlation with BMD at any site. The prevalence of VF was positively associated with age (p = 0.018) and negatively associated with BMD at FN (p = 0.002) and TH (p = 0.013). Osteoporosis and VF are common in asymptomatic Indian males aged 60 years and above. Screening for osteoporosis and instant vertebral assessment may be recommended earlier than currently existing guidelines.
authors.affiliation: Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India.
authors.forename: Khurshid A
authors.initials: KA
authors.lastname: Bhat
authors.affiliation: Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India.
authors.forename: Manisha
authors.initials: M
authors.lastname: Kakaji
authors.affiliation: Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Awasthi
authors.affiliation: Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Shukla
authors.affiliation: Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Dubey
authors.affiliation: Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Srivastava
authors.affiliation: Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India.
authors.forename: Uttam
authors.initials: U
authors.lastname: Singh
authors.affiliation: Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India. Electronic address: sushilguptasgpgi@gmail.com.
authors.forename: Sushil K
authors.initials: SK
authors.lastname: Gupta
mesh_terms: D015502:Absorptiometry, Photon; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology; D015897:Comorbidity; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000453:epidemiology; D007194:India / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D014808:Vitamin D Deficiency / Q000453:epidemiology
keywords: BMD; IVA; osteoporosis; vertebral fracture