Original Article

Estimates of the proportion of older white men who would be recommended for pharmacologic treatment by the new US National Osteoporosis Foundation guidelines

M.G. Donaldson 1 *, P.M. Cawthon 1, L.Y. Lui 1, J.T. Schousboe 2, K.E. Ensrud 3, B.C. Taylor 3, J.A. Cauley 4, T.A. Hillier 5, T.T. Dam 6, J.R. Curtis 7, D.M. Black 8, D.C. Bauer 8, E. Orwoll 9, S.R. Cummings 1 8, Osteoporotic Fractures in Men (MrOS) Study Group

1San Francisco Coordinating Center, California Pacific Medical Center, San Francisco, CA, USA 2Park Nicollet Health Services and Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA 3University of Minnesota and CCDOR VA Medical Center, Minneapolis, MN, USA 4University of Pittsburgh, Pittsburgh PA, USA 5Kaiser Permanente Center for Health Research, Portland, OR, USA 6Columbia University, Division of Geriatrics and Aging, New York, NY, USA 7University of Alabama at Birmingham, Birmingham, AL, USA 8University of California San Francisco, San Francisco, CA, USA 9Bone and Mineral Research Unit, Oregon Health and Sciences University, Portland, OR, USA

email: M.G. Donaldson (mdonaldson@sfcc-cpmc.net) P.M. Cawthon (pmannen@sfcc-cpmc.net) L.Y. Lui (llui@sfcc-cpmc.net) J.T. Schousboe (John.Schousboe@ParkNicollet.com) K.E. Ensrud (ensru001@umn.edu) B.C. Taylor (brent.taylor2@va.gov) J.A. Cauley (jcauley@pitt.edu) T.A. Hillier (teresa.hillier@kpchr.org) T.T. Dam (td2265@columbia.edu) J.R. Curtis (jcurtis@uab.edu) D.M. Black (dblack@psg.ucsf.edu) D.C. Bauer (dbauer@psg.ucsf.edu) E. Orwoll (orwoll@ohsu.edu) S.R. Cummings (scummings@sfcc-cpmc.net)

^*Correspondence to M.G. Donaldson, SF Coordinating Center, 185 Berry St., Suite 5700, Lobby 5, San Francisco, CA 94107. Phone: 415.600.7427; Fax: 415.514.8150.

Conflicts of Interest Dr. Schousboe has received research support from Eli Lilly & Company. He has also received consulting fees from Roche. Dr. Cauley has received research support from Merck & Company, Eli Lilly & Company, Pfizer Pharmaceuticals, Proctor & Gamble and Novartis Pharmaceuticals. She has also received consulting fees from Novartis. Dr. Curtis has received research support from Amgen, Novartis, merck, Roche, Eli Lilly & Company, and Proctor and Gamble. He has received consulting fees or honorarium from Amgen, Roche, Eli Lilly & Company, Novartis and Proctor and Gamble. Dr. Black has received research support from Novartis Pharmaceutical and Roche. He has received consulting fees from GSK. He has received speaking fees from Merck & Company. Dr. Bauer has received consulting fees from Merck & Company, Tethys and Zelos. He has received research support from Amgen and Novartis Pharmaceuticals. Dr. Cummings has received research support, has consulted for, or received honoraria from Amgen, Eli Lilly & Company, Pfizer, Zelos, Proctor & Gamble, and GSK. All other authors have no conflicts of interest.

Keywords

osteoporosis • men • treatment • guidelines • epidemiology • bone density

Abstract

The new US National Osteoporosis Foundation Clinician's Guide to Prevention and Treatment of Osteoporosis includes criteria for recommending pharmacologic treatment based on history of hip or vertebral fracture, femoral neck (FN) or spine BMD T-scores -2.5, and presence of low bone mass at the FN or spine plus a 10 year risk of hip fracture 3% or of major osteoporotic fracture 20%. The proportion of men who would be recommended for treatment by these guidelines is not known. We applied the NOF criteria for treatment to men participating in the Osteoporotic Fractures in Men Study (MrOS). To determine how the MrOS population differs from the general US population of Caucasian men aged 65 years and older, we compared men in MrOS to men who participated in the National Health and Nutrition Examination Survey (NHANES) III on criteria included in the NOF treatment guidelines that were common to both cohorts. Compared with NHANES III, men in MrOS had higher femoral neck BMD. Application of NOF guidelines to MrOS data estimated that at least 34% of U.S. white men age 65 and 49% of those age 75 years would be recommended for drug treatment. Application of the new NOF Guidelines would result in recommending a very large proportion of white men in the United States for pharmacologic treatment of osteoporosis, for whom many the efficacy of treatment is unknown. © 2010 American Society for Bone and Mineral Research

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Received: 7 July 2009; Revised: 5 October 2009; Accepted: 26 January 2010

Digital Object Identifier (DOI)

10.1002/jbmr.55  About DOI