Inequities Across the Spectrum of Osteoporosis Care and Post-Fracture Management in Men

Sex specific differences in the determinants, occurrence, and distribution of osteoporosis and osteoporotic fractures play a pivotal role in the implementation of timely surveillance, prevention and effective treatment approaches. This review is aimed at synthesizing recently published scientific evidence on disparities in the epidemiology and management of osteoporosis and related fragility fractures in men.

Several studies have identified race-, sex-, geographic-, socioeconomic-, and comorbidity-based disparities in osteoporosis care. Over the last decade, the awareness and imperative for identifying osteoporosis in men have increased. Nonetheless, the treatment gap is increasing and osteoporosis in men remains severely underappreciated and undertreated. Fewer studies in men have focused on the factors beyond osteoporosis awareness. Recent data of individuals aged 50 years and older show an alarmingly greater increase in hip fractures in men compared to women. This coupled with the existing knowledge of greater disability burden and excess mortality due to fragility fractures in men is a cause of public health concern. This review offers a comprehensive examination of widespread and profound disparities across the spectrum of osteoporosis care and post-fracture management in men and highlights the considerable health economic aspect of this burden. We call for targeted multifaceted interventions: develop novel methods to engage patients and health professionals, increase screening and treatment of osteoporosis in men, conduct epidemiological studies focused on disease phenotyping and risk factor assessment, studies on the identification of perceptions and barriers to effective screening and treatment, expansion and further evaluation of cost-effective therapies and primary prevention strategies for fractures, implementation of fracture liaison services to address the treatment gap in secondary prevention, and promote inclusivity in outcome studies and therapeutic trials. These interventions are paramount to reduce inequities in osteoporosis care and post-fracture care in men.