Margaret L Gourlay1, Robert A Overman2, Jason P Fine3, Guillaume Filteau3, Peggy M Cawthon4, John T Schousboe5, Eric S Orwoll6, Timothy J Wilt7, Tuan V Nguyen8, Nancy E Lane9, Pawel Szulc10, Brent C Taylor11, Thuy-Tien Dam12, Carrie M Nielson13, Jane A Cauley14, Elizabeth Barrett-Connor15, Howard A Fink16, Jodi A Lapidus17, Deborah M Kado18, Susan J Diem19, Kristine E Ensrud11. 1. Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina. Electronic address: margaret_gourlay@med.unc.edu. 2. Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina. 3. Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina. 4. Research Institute, California Pacific Medical Center, San Francisco, California. 5. Department of Rheumatology, Park Nicollet Health Services, Minneapolis, Minnesota; Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota. 6. Bone and Mineral Unit, Oregon Health and Science University, Portland, Oregon. 7. Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, Minnesota. 8. Garvan Institute of Medical Research, UNSW School of Public Health and Community Medicine, New South Wales, Australia; Centre for Health Technologies, University of Technology, Sydney, Australia. 9. Departments of Medicine and Division of Rheumatology, Center for Musculoskeletal Health, UC Davis Health System, Sacramento, California. 10. INSERM UMR 1033, University of Lyon, Lyon, France. 11. Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, Minnesota; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota. 12. Department of Medicine, Columbia University, New York, New York. 13. Bone and Mineral Unit, Oregon Health and Science University, Portland, Oregon; School of Public Health, Oregon Health and Science University, Portland, Oregon. 14. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania. 15. Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California. 16. Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, Minnesota; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Geriatric Research Education and Clinical Center, Minneapolis VA Health Care System, Minneapolis, Minnesota. 17. School of Public Health, Oregon Health and Science University, Portland, Oregon. 18. Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California; Department of Medicine, University of California, San Diego, La Jolla, California. 19. Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
Abstract
INTRODUCTION: For older men who undergo bone mineral density (BMD) testing, the optimal osteoporosis screening schedule is unknown. Time-to-disease estimates are necessary to inform screening intervals. METHODS: A prospective cohort study of 5,415 community-dwelling men aged ≥65 years without hip or clinical vertebral fracture or antifracture treatment at baseline was conducted. Participants had concurrent BMD and fracture follow-up between 2000 and 2009, and additional fracture follow-up through 2014. Data were analyzed in 2015. Time to incident osteoporosis (lowest T-score ≤ -2.50) for men without baseline osteoporosis, and time to hip or clinical vertebral fracture or major osteoporotic fracture for men without or with baseline osteoporosis, were estimated. RESULTS: Nine men (0.2%) with BMD T-scores >-1.50 at baseline developed osteoporosis during follow-up. The adjusted estimated time for 10% to develop osteoporosis was 8.5 (95% CI=6.7, 10.9) years for those with moderate osteopenia (lowest T-score, -1.50 to -1.99) and 2.7 (95% CI=2.1, 3.4) years for those with advanced osteopenia (lowest T-score, -2.00 to -2.49) at baseline. The adjusted times for 3% to develop a first hip or clinical vertebral fracture ranged from 7.1 (95% CI=6.0, 8.3) years in men with baseline T-scores > -1.50 to 1.7 (95% CI=1.0, 3.1) years in men with baseline osteoporosis. CONCLUSIONS: Men aged 65 years and older with femoral neck, total hip, and lumbar spine BMD T-scores >-1.50 on a first BMD test were very unlikely to develop osteoporosis during follow-up. Additional BMD testing may be most informative in older men with T-scores ≤-1.50.
INTRODUCTION: For older men who undergo bone mineral density (BMD) testing, the optimal osteoporosis screening schedule is unknown. Time-to-disease estimates are necessary to inform screening intervals. METHODS: A prospective cohort study of 5,415 community-dwelling men aged ≥65 years without hip or clinical vertebral fracture or antifracture treatment at baseline was conducted. Participants had concurrent BMD and fracture follow-up between 2000 and 2009, and additional fracture follow-up through 2014. Data were analyzed in 2015. Time to incident osteoporosis (lowest T-score ≤ -2.50) for men without baseline osteoporosis, and time to hip or clinical vertebral fracture or major osteoporotic fracture for men without or with baseline osteoporosis, were estimated. RESULTS: Nine men (0.2%) with BMD T-scores >-1.50 at baseline developed osteoporosis during follow-up. The adjusted estimated time for 10% to develop osteoporosis was 8.5 (95% CI=6.7, 10.9) years for those with moderate osteopenia (lowest T-score, -1.50 to -1.99) and 2.7 (95% CI=2.1, 3.4) years for those with advanced osteopenia (lowest T-score, -2.00 to -2.49) at baseline. The adjusted times for 3% to develop a first hip or clinical vertebral fracture ranged from 7.1 (95% CI=6.0, 8.3) years in men with baseline T-scores > -1.50 to 1.7 (95% CI=1.0, 3.1) years in men with baseline osteoporosis. CONCLUSIONS:Men aged 65 years and older with femoral neck, total hip, and lumbar spine BMD T-scores >-1.50 on a first BMD test were very unlikely to develop osteoporosis during follow-up. Additional BMD testing may be most informative in older men with T-scores ≤-1.50.
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