A bone mineral density (BMD) evaluation carried out utilizing CT imaging knowledge is an efficient solution to establish, observe, and help remedy of osteoporosis in males — a affected person inhabitants that tends to not get this sort of screening, researchers have discovered.
A crew led by Tony Keaveny, PhD, of the College of California, Berkeley, reported that each women and men identified with osteoporosis through a digital, biomechanical CT (BCT) BMD software benefitted from drug remedy to forestall hip fractures. The examine outcomes had been revealed June 11 within the Journal of Bone and Mineral Analysis.
“We discovered that the discount in threat of hip fracture related to remedy didn’t differ between the sexes,” Keaveny and colleagues wrote. “These outcomes display that treating osteoporosis in sufferers at excessive threat of hip fracture ought to scale back the danger of hip fracture equally in each sexes.”
Earlier analysis has advised that osteoporosis remedy ought to forestall hip fracture equally in each sexes, however due to its expense, randomized scientific trials to display that definitively “haven’t been carried out and should by no means be,” the group defined.
“In consequence, osteoporosis testing and remedy shouldn’t be as broadly adopted for males as it’s for girls,” it wrote.
Keaveny and colleagues have developed a “digital stress take a look at” referred to as VirtuOst that makes use of knowledge taken from CT imaging to evaluate BMD. Developed within the early 2000s below the auspices of startup agency O.N. Diagnostics, the software produces bone power measurements, a dual-energy x-ray absorptiometry (DEXA)-equivalent BMD T-score on the hip, and a volumetric BMD evaluation of trabecular bone on the backbone. It is coated by Medicare.
The U.S. Preventive Companies Process Power (USPSTF) has not beneficial males be screened for osteoporosis, however that does not imply they should not be, Keaveny’s crew famous.
“Osteoporosis causes over a million bone fractures yearly in the US, hip fractures being essentially the most severe and dear,” the group defined. “About one in 4 hip fractures happen in males, and males have larger mortality after hip fracture than ladies. Whereas the paradigm of treating ladies for osteoporosis to forestall fractures is nicely established, this isn’t so for males. For instance, regardless of the supply of a number of drug remedies proven in randomized scientific trials to scale back threat of hip fracture in ladies, no such proof exists for males — not due to any failed trials however as a result of such trials haven’t been performed. Due partially to this lack of proof, the [USPSTF] doesn’t advocate diagnostic screening of osteoporosis for males. In consequence, many males at excessive threat of osteoporotic fractures go untested and untreated for osteoporosis.”
The group performed a examine that included knowledge from 11,461 sufferers within the Kaiser Permanente healthcare system in Southern California ages 65 or older who had a CT scan that included visualization of the hip between 2005 and 2018 (7,913 ladies and three,548 males). Out of the dataset, the group chosen people who had a primary hip fracture after the CT scan and an equal variety of sex-matched, randomly chosen sufferers (2,413 ladies and 792 males).
Keaveny and colleagues analyzed all who examined constructive for osteoporosis (that’s, with a DEXA-equivalent hip bone mineral density T-score equal to or lower than -2.5, measured utilizing VirtuOst) and tracked who had been handled (they outlined “handled” as at the very least six months of any osteoporosis treatment by prescription fill throughout a two-year follow-up interval and “not-treated” as no prescription fill). They then calculated sex-specific odds ratios of hip fracture for handled versus not-treated sufferers, adjusting for age, BMD T-score, BMD remedy, physique mass index (BMI), race and ethnicity, and different threat components akin to alcohol dependence, smoking, diabetes, and rheumatoid arthritis.
At two-year follow-up, 33.9% of the ladies (750 out of two,211) and 24% of the lads (175 of 728) had been handled, primarily with the drug alendronate; 51.3% and 66.3%, respectively, weren’t handled; and 721 and 269, respectively, had a primary hip fracture because the CT scan. The crew discovered a comparable odds ratio for each ladies and men of hip fracture for handled versus not handled, at 0.26 for girls and 0.21 for males, and famous that “sensitivity and stratified analyses confirmed these traits, together with outcomes at five-year follow-up.”
Keaveny and colleagues hope the examine outcomes will change how males are managed for osteoporosis.
“We didn’t tackle cost-effectiveness of diagnostic screening and remedy for males, nor what’s the optimum solution to outline ‘high-risk’ for initiating remedy for both intercourse,” they wrote. “Nonetheless, our examine does present extra conclusive proof, notably when additionally contemplating the accrued literature, that osteoporosis remedy in scientific apply prevents hip fractures equally in high-risk women and men, whether or not ‘high-risk’ is outlined by DEXA, [the Fracture Risk Assessment Tool, or FRAX], or BCT. Given the devastating results of hip fracture, particularly for males, scientific pointers for osteoporosis testing and remedy ought to be up to date to mirror this new proof.”
The entire examine may be discovered right here.
Disclosure: Keaveny is chief science officer at O.N. Diagnostics, the maker of VirtuOst. Research co-authors David Lee, PhD, and David Kopperdahl, PhD, have fairness pursuits within the firm.
