The incremental risk of fragility fractures in aging men

Authors

A R. Agarwal, Department of Orthopaedic Surgery, George Washington University School of Medicine and, Health Sciences, Washington, DC, USA. amil_agarwal@gwmail.gwu.edu.
O Tarawneh, Department of Orthopaedic Surgery, New York Medical College, Valhalla, NY, USA.
J S. Cohen, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelpha, PA, USA.
A Gu, Department of Orthopaedic Surgery, George Washington University School of Medicine and, Health Sciences, Washington, DC, USA.
K F. Moseley, Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA.
J N. DeBritz, Department of Orthopaedic Surgery, George Washington University School of Medicine and, Health Sciences, Washington, DC, USA.
G J. Golladay, Department of Orthopaedic Surgery, Virginia Commonwealth University Health Center, Richmond, VA, USA.
S C. Thakkar, Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA.

Document Type

Journal Article

Publication Date

11-8-2023

Journal

Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA

DOI

10.1007/s00198-023-06956-8

Keywords

Fragility fractures; Men; Stratum-specific likelihood ratio; Thresholds

Abstract

INTRODUCTION: While the United States Preventative Services Task Force recommends osteoporosis screening for women 65 years and older, there is no definitive recommendation for routine osteoporosis screening in men. The purpose of this study was to determine the age at which the odds of fragility fractures (FFx) increase in men to help guide future policy discussions evaluating an optimal screening strategy in this population. METHODS: Men older than 49 years were identified in the PearlDiver Patient Records Database. Patients were excluded if they had a prior fragility fracture, if they were at high risk for osteoporosis due to comorbidities, or if they carried a diagnosis of and/or were on treatment for osteoporosis. The prevalence of FFx was trended for each age group. A stratum-specific likelihood ratio (SSLR) analysis was conducted to identify data-driven strata that maximize the incremental FFx risk by age for men. Logistic regression analyses controlling for potential confounders were conducted to test these identified strata. RESULTS: The incidence of FFx started to increase after the age of 64 years for men. Further, the identified data-driven age strata associated with a significant and incremental difference in fragility fractures were the following: 50-64, 65-69, 70-72, 73-75, 76-78, 79-80, and 81+. When compared to the youngest age stratum (50-64 years), multivariable regression showed the risk of fragility fracture incrementally increased starting in those aged 70-72 (RR, 1.31; 95% CI. 1.21-1.46; p < 0.001) with the highest risk in those aged 81+ (RR, 5.35; 95% CI, 5.10-5.62; p < 0.001). CONCLUSION: In men without a pre-existing history of osteoporosis, the risk of fragility fractures starts to increase after the age of 70. Further work building upon these data may help to identify a specific age at which routine bone health screening in males can help to minimize fractures and their associated morbidity and mortality.

APA Citation

Agarwal, A R.; Tarawneh, O; Cohen, J S.; Gu, A; Moseley, K F.; DeBritz, J N.; Golladay, G J.; and Thakkar, S C., "The incremental risk of fragility fractures in aging men" (2023). GW Authored Works. Paper 3830.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3830

Department

School of Medicine and Health Sciences Student Works