Guidelines for Bone Density Testing in

Determining when testing is appropriate in men has become increasingly important with the advent of prescription pharmacologic therapy for the treatment of osteoporosis in men. The prevalence of osteoporosis in men, although not as great as that in women, is high. In one study (19), the prevalence of osteoporosis in a population-based sample of 348 men was 19% when osteoporosis was defined as 2.5 SD or more below the average peak BMD for men. The major risk factors for osteoporosis in men are not dissimilar from those seen in women: cigarette smoking, advancing age, risk of falls, and the presence of diseases or the use of medications known to affect bone metabolism (20-22). Heavy alcohol consumption is considered a major risk factor in men, more so than in women. Other risk factors include a sedentary lifestyle, lifelong low calcium intake, and low body weight.

At the present time, prudent recommendations (23) for bone density testing in men do not differ considerably from the 1998 clinical guidelines for bone density testing in women from the NOF. Testing in men is recommended in the following circumstances:

• Men with low trauma fractures.

• Men with prevalent spine deformities.

• Men with radiographic evidence of osteopenia.

• Men with medical conditions associated with an increased risk of bone loss such as hyperparathyroidism or overt hypogonadism.

• Men receiving medications associated with an increased risk of bone loss such as corticosteroids.

Recommending BMD testing in men on the basis of age alone, such as the recommendation to test women age 65 and older regardless of other risk factors, is more

Table 7-7

A Comparison of Major Guidelines for Bone Density Testing for the Detection of Osteoporosis in Women

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