Osteoporosis in men: are we referring enough for DXA and how?

The aim of the study is to determine the pattern of male referrals to an osteodensitometry unit in a tertiary hospital in UAE. In this study, we reviewed the records of male patients referred for dual X-ray absorptiometry over 9 months since the establishment of the unit. Indications for scanning were categorized into high and medium risk and infrequent causes of osteopenia/osteoporosis. They were ranked according to frequency. The outcome was documented by category and patients were considered normal when they have bone mineral densities (BMD) over 0.82 g/cm², osteopenia between 0.60 and 0.82 g/cm², and osteoporosis below 0.60 g/cm² for hips and lumbar spine. The site with the lowest value was taken as representative of the patient’s BMD status. The ages of the patients ranged from 16 to 91 years (mean of 55.2 years). Male referrals made up 8.8% (71/805) over the 9-month period. The number of indications was 83 accounting for 1.16 per patient. Most common reasons were patients on corticosteroid therapy (20.5%), bone rarefaction on radiographs (13%), and fragility fractures (12%). Others included back pain, general aches and pains, querying osteoporosis, and miscellaneous causes that made up 8.5% each. These were followed by immobilization, (6%) arthropathies (6%), excess alcohol intake (3.5%), aging, (2.5%), and hepatorenal disorders (2.5%). A positive family history of osteoporosis, treatment for neoplasia, smoking, and chronic obstructive airway disease (1% each) were the least common reasons for referral. Thirty-five patients (49%) had osteopenia, 16 (22.5%) had osteoporosis, and 20 (28%) were normal. The low referral rate and relatively high normal outcome among men suggest that osteoporosis is still viewed as a disease of females. This aberrant referral pattern, when viewing the majority of indications, reflects an inability to prioritize the reasons for referral. It is prudent, therefore, to instill an awareness of the increasing importance of osteoporosis in men in the minds of the referring clinicians.