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MEDICINE | THE HEALTHY MAN

The peril of treating osteoporosis as only a woman's disease

November 11, 2002|Timothy Gower | Special to The Times

It's a familiar complaint: Men receive better medical care than women. Research has shown, for instance, that male heart attack victims are given more aggressive therapy than female heart patients. The problem has been blamed on bias -- doctors tend to think of heart attacks as a predominantly male problem. But a new study suggests that men may also be undertreated for conditions associated primarily with women.

About 10 million Americans have osteoporosis, the disease that causes bones to become brittle and weak, and about 20% of all sufferers are male, according to the National Osteoporosis Foundation. However, a report published last month in the Archives of Internal Medicine found that many American men with osteoporosis aren't receiving the care they need.

Doctors at St. Luke's Episcopal Hospital in Houston followed 363 patients who had suffered hip fractures. Roughly one-third were male, and the average age of the patients was about 80. Most of the men and women broke their hips in falls, suggesting that their bones were quite fragile. Given their age and the nature of their injuries, most experts would agree that these patients should have been considered prime candidates for a diagnosis of osteoporosis. Yet, upon being discharged from the hospital, only five out of 110 male patients -- 4.5% -- were being treated for osteoporosis, contrasted with 27% of the women.

The Houston researchers, led by bone physiologist Gary Kiebzak, periodically checked up on the patients for five years. The percentage of men who were put on some form of bone-health regimen (usually vitamin supplements) eventually rose to 27%. But the comparable figure for women was much higher -- 71%. Women also were twice as likely as the men to receive more aggressive treatment, such as prescription drugs for osteoporosis and bone-density tests.

Although women have a greater risk of developing osteoporosis, men are more likely to die of complications related to a serious fracture, such as blood clots. In the Houston study, 32% of the male patients died within a year of being discharged compared to 17% of the women.

Why did the men get such spotty care? Kiebzak believes it's because male osteoporosis "isn't on everybody's radar screen." While orthopedists fix more severe broken bones, long-term treatment of patients who suffer fractures is more likely to be handled by primary-care doctors.

Kiebzak can only speculate about why the male patients he studied were so unlikely to be diagnosed with osteoporosis, but he suspects it's because many primary-care physicians still associate weak bones with women. That's a view reinforced by news stories about osteoporosis and product advertising.

Dr. Eric Orwoll of the Oregon Health & Science University points out that doctors lack uniform guidelines for diagnosing and treating osteoporosis in men. A recent development may help. The gold standard for diagnosing osteoporosis is a special form of X-ray that measures bone density.

Last month, the International Society for Clinical Densitometry established new guidelines to help physicians decide when male patients should undergo bone-density testing. Men who have broken bones from low-impact forces, such as falling down (so-called "fragility fractures"), should be tested, according to the society's new guidelines. So should men with increased risk factors for bone deterioration. That includes low testosterone levels, use of corticosteroid medications (such as prednisone), cigarette smoking and alcohol abuse.

The society also recommends bone-density testing for all men over age 70, though Orwoll says there's little data to suggest such a sweeping measure would be cost-effective.

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Massachusetts freelance writer Timothy Gower can be reached at tgower@attbi.com. The Healthy Man runs the second Monday of the month.

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