Patterns in the Diagnosis and Treatment of Osteoporosis in Men: A Questionnaire-based Survey in Central and Eastern European Countries

M. A. Boyanov 1 , E. Czerwinski 2 , A. Shinkov 3 , V. Palička 4 , P. Lakatos 5 , C. Poiana 6 , J. Payer 7 , Z. Killinger 7 , T. Kocjan 8 , O. Lesnyak 9 , 10 , G. Holzer 11  and H. Resch 12
  • 1 Department of Internal Medicine, Clinic of Endocrinology and Metabolism, University Hospital “Alexandrovska”, Medical University, Sofia, Bulgaria
  • 2 Jagiellonian University Medical College, Faculty of Health Sciences, Department of Bone and Joint Diseases, Cracow, Poland
  • 3 Clinic of Thyroid and Bone Metabolic Diseases, University Hospital of Endocrinology “Acad. Ivan Penchev”, Medical University, Sofia, Bulgaria
  • 4 Osteocentra, University Hospital and Charles University, School of Medicine, Hradec Kralove
  • 5 1st Department of Medicine, Semmelweis University, Budapеst, Hungary
  • 6 Department of Endocrinology, National Institute of Endocrinology, University of Medicine and Pharmacy, Bucharest, Romania
  • 7 5th Department of Internal Medicine, University Hospital, Medical Faculty of Comenius University, Bratislava, Slovakia
  • 8 Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
  • 9 Urals State Medical University, , Yekaterinburg, Russian Federation
  • 10 North-Western State Medical University, , Saint Petersburg, Russian Federation
  • 11 Department of Orthopedic Surgery, Medical University of Vienna, Vienna, Austria
  • 12 Metabolic Bone Diseases, Medical Faculty, “Sigmund Freud” University, Department of Internal Medicine II, St. Vincent Hospital Vienna, Academic Teaching Hospital of the Medical University, Vienna, Austria

Summary

To assess the current practice patterns in the diagnosis and treatment of male osteoporosis based on questionnaires. Questionnaires were presented and filled out by osteoporosis experts from Austria, Bulgaria, the Czech Republic, Hungary, Poland, Romania, Slovakia, Slovenia and Russia. The questions included focused on the proportion of male referrals to DXA, the main reasons for referral, the preferred measurement sites and reference database, the definition of male osteoporosis, needed laboratory investigations, data on calcium and vitamin D supplementation as well as on treatment modalities and their reimbursement rate. Men comprised 5 to 10% of all DXA referrals. The main reasons for referral were low back pain and fractures. Most of the respondents used the International male reference database. The diagnosis of osteoporosis was based mainly on a T-score below −2.5 after the age of 50, but a few respondents added fractures as a necessary condition. Only 1/3 of men visiting DXA sites are expected to have normal BMD. A consensus for the use of laboratory investigations in male osteoporosis is practically lacking. Treatment modalities include alendronate, risedronate, zoledronate, denosumab, rhPTH and strontium (with some restrictions for the latter three). Data on treatment adherence and persistence are generally lacking except for Austria, Romania and Slovakia. The levels of reimbursement vary a lot across countries. Osteoporosis in men is an under-recognized problem in CEE countries, leading to a tremendous gap in the diagnosis and treatment.

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