1017 — Recognition and Treatment of Male Osteoporosis Is Low in at Least One VISN

LaFleur J (Salt Lake City IDEAS Center), Pickard SG (Salt Lake City IDEAS Center), Nebeker JR (Salt Lake City IDEAS Center)

Objectives:
The prevalence of osteoporosis among males over age 50 in the US ranges from 3% of Hispanics and 4% of Blacks to 7% of White and Asian men. The expected rate of fragility fractures for males over age 50 is 25% in their remaining lifetimes. In secondary osteoporosis, bisphosphonates have been shown to reduce the risk of these fractures by 67-81%. The purpose of this analysis was to characterize the disease burden of osteoporosis and fragility fractures among male veterans in one VISN and proportions treated with bisphosphonates.

Methods:
We used the clinical data warehouse of VISN 19 to create a cohort of male veterans over the age of 49 who received care during the calendar years of 2005 and 2006. We identified the proportion with a diagnosis of osteoporosis, the proportion with a history of non-traumatic fragility fracture, and the proportion that were prescribed an oral bisphosphonate (alendronate, ibandronate, or risedronate).

Results:
129,476 males age 50 and over received care. The mean age of the cohort was 67.6 (SD 10.6). Among the 49% with recorded race information, 92% were Caucasian. An osteoporosis diagnosis was reported in only 1.9% of patients (n=2,401). The prevalence of those with a fragility fracture during the two-year period was 1.3% (n=1,691). Among those that had a fragility fracture, only 6.3% (n=106) had a prescription for an oral bisphosphonate. Further analysis on risk adjusted incidence and on treatment following new fractures will be presented over a longer period of follow up.

Implications:
In one VISN, the proportion of men diagnosed with osteoporosis is less than a third of the national rate. Moreover, only a small fraction of veterans with fragility fractures appear to be receiving oral bisphosphonates, the current standard of care for men.

Impacts:
Osteoporosis is an under-recognized threat to male veterans in at least one VISN. Interventions should be explored to increase the diagnosis and adequate treatment of osteoporosis in the Veterans Health Administration.