Frequency of low bone mass in elderly males attending an academic geriatric clinic: a pilot study

The objective of this prospective study was to evaluate the frequency of low bone density in elderly males seen in an academic geriatric practice and to evaluate physician awareness of male osteoporosis among academic geriatricians. The participants were elderly community-dwelling ambulatory males aged 65 years and older (n = 35). The mean age was 80.7 +/- 8.2 years, with eight subjects in the 65-74 years range, 16 in the 75-84 years range and 11 over 85 years. Only 5/35 utilized an assistive device for ambulation. Bone mineral density (BMD) was measured using a heel ultrasound (QUS-2 calcaneal ultrasonometer). Clinical risk factors, gait and balance were evaluated (Tinetti scale). Results of BMD were communicated to the attending geriatrician. In all 7/35 participants had a calcaneal T-score of < or = -2.5 indicating osteoporosis, of these 50% were > 85 years; 7/35 had t score of -1 to -2.5 indicating osteopenia, of these 50% were 75-84 years; and 21/35 had a T-score > -1 indicating normal BMD). Overall, 14 of the 35 subjects studied had low bone density. Gait disorders were seen in 18/35 subjects (p < 0.05), more commonly in the oldest subjects. Risk factors for osteoporosis-related fractures included smoking (n = 22, 63%, p = 0.57), gait abnormalities (n = 18, 51%, p < 0.05) and alcohol use (n = 13, 37%, p = 0.39). Low bone mass (osteopenia or osteoporosis) was not addressed (by record notations, request for DEXA, laboratory testing or medical treatment) within 6 months by the majority of geriatricians (3/5). This pilot study shows a high frequency of low bone density in elderly males seen in an academic geriatric practice. This frail population presents with significant balance and gait disorders, and the coexistence of these two risk factors predisposes them to the development of hip fracture. This study also underscores the importance of increasing awareness of osteoporosis in males among geriatricians. Limitations to this study are that bone density was measured with the QUS-2 calcaneal ultrasonometer, and that female reference values were utilized. These limitations potentially under-estimate the prevalence of bone loss in males.