Osteoporos Int (2015) 26:1619–1627 DOI 10.1007/s00198-015-3035-z
ORIGINAL ARTICLE
Fracture incidence in a large cohort of men age 30 years and older with osteoporosis A. D. Manthripragada & C. D. O’Malley & U. Gruntmanis & J. W. Hall & R. B. Wagman & P. D. Miller
Received: 29 September 2014 / Accepted: 11 January 2015 / Published online: 24 January 2015 # International Osteoporosis Foundation and National Osteoporosis Foundation 2015
Abstract Summary In this large retrospective study of men with presumed osteoporosis, we estimate the rate of osteoporosisrelated fractures in men age ≥30 years. Our results suggest that spine and hip fractures continue to be a considerable disease burden for osteoporotic men of all ages. Introduction The purposes of this study were to describe a cohort of men with presumed osteoporosis and estimate the incidence rates of fractures by age. Methods Using US administrative claims data, we identified 43,813 men ≥30 years old with an osteoporosis diagnosis or use of an osteoporosis medication. Men were followed for a minimum of 12 months after diagnosis or treatment of osteoporosis (index date), until the earliest of fracture (hip, spine, pelvis, distal femur, humerus, wrist, forearm), disenrollment, or study end date. Results During the study period, there were 3834 first fractures following the index date and 3303 fractures in the 6month period prior to the diagnosis/treatment of osteoporosis. Incidence rates of osteoporosis-related fracture, estimated from the index date onward, increased with age, although did not significantly differ from one another in younger age groups (30–49 and 50–64 years). Spine fractures had the A. D. Manthripragada (*) : C. D. O’Malley : R. B. Wagman Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA 91320, USA e-mail: [email protected] U. Gruntmanis Division of Endocrinology, University of Texas, Southwestern Medical Center, Dallas, TX, USA J. W. Hall Ardea Biosciences, San Diego, CA, USA P. D. Miller Colorado Center for Bone Research, University of Colorado Health Sciences Center, Lakewood, CO, USA
highest incidence rate in men across all age groups, increasing from 10.8 per 100,000 person-years (p-yrs) (95 % confidence interval (CI) 9.1, 12.7), 12.2 per 100,000 p-yrs (95 % CI 11.2, 13.3), and 15.3 per 100,000 p-yrs (95 % CI 13.8, 16.9) in men 30–49, 50–64, and 65–74 years to 33.4 per 100,000 p-yrs (95 % CI 31.5, 35.4) in men ≥75 years. Hip fractures were the second most common, with the incidence rate reaching 16.2 per 100,000 (95 % CI 14.9, 17.6) in the ≥75-year group. Conclusion These incidence rates suggest that spine and hip fractures are a considerable disease burden for men of all ages diagnosed and/or treated for osteoporosis. Keywords Epidemiology . Fracture . Male . Osteoporosis . Trauma
Introduction Often perceived as a disease of women, osteoporosis is also a major disease of men. As in women, osteoporosis in men is defined as a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration leading to increased bone fragility [1]. Osteoporosis is frequently underdiagnosed and undertreated in men [2, 3]. Osteoporosis in men is associated with a significant fracture burden and related mortality. Of an estimated worldwide annual incidence of approximately 9 million osteoporosisrelated fractures in persons ≥50 years, 30 % of hip fractures, 20 % of forearm fractures, 42 % of clinical vertebral fractures, and 25 % of humerus fractures occurred in men, for a total of nearly 3.5 million fractures in men [4]. The lifetime risk of an osteoporosis-related fracture in men has been reported to be between 13 and 22 % [5]. Both short- and long-term mortality are associated with low-trauma fractures in men [6], with the
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1-year mortality after a hip fracture nearly two times higher for men than for women [7–9]. Additionally, men have a significantly worse functional outcome following hip fracture than women [10]. Although previous studies have estimated the incidence of fractures in older men with osteoporosis, the epidemiology of osteoporotic fractures in younger men is relatively unstudied [11]. Several studies have described the prevalence of osteoporosis (defined either by a low-trauma fracture or bone mineral density (BMD) criteria) in young men, but these studies do not examine osteoporosis-related fracture incidence rates, perhaps because of small sample size, nor do they present data allowing for the calculation of fracture incidence rates in osteoporotic young men [12–16]. Moreover, fracture incidence reports in younger men typically do not indicate whether subjects are diagnosed with osteoporosis. The aims of this study were to describe a cohort of men with presumed osteoporosis, identified by osteoporosis diagnoses or pharmacologic treatment claims, and to estimate the incidence rates of a variety of fractures in this cohort. We addressed the dearth of information on osteoporosis-related fractures among younger men with presumed osteoporosis by including men as young as 30 years of age in our study. Since studies report the prevalence of osteoporosis in men
ORIGINAL ARTICLE
Fracture incidence in a large cohort of men age 30 years and older with osteoporosis A. D. Manthripragada & C. D. O’Malley & U. Gruntmanis & J. W. Hall & R. B. Wagman & P. D. Miller
Received: 29 September 2014 / Accepted: 11 January 2015 / Published online: 24 January 2015 # International Osteoporosis Foundation and National Osteoporosis Foundation 2015
Abstract Summary In this large retrospective study of men with presumed osteoporosis, we estimate the rate of osteoporosisrelated fractures in men age ≥30 years. Our results suggest that spine and hip fractures continue to be a considerable disease burden for osteoporotic men of all ages. Introduction The purposes of this study were to describe a cohort of men with presumed osteoporosis and estimate the incidence rates of fractures by age. Methods Using US administrative claims data, we identified 43,813 men ≥30 years old with an osteoporosis diagnosis or use of an osteoporosis medication. Men were followed for a minimum of 12 months after diagnosis or treatment of osteoporosis (index date), until the earliest of fracture (hip, spine, pelvis, distal femur, humerus, wrist, forearm), disenrollment, or study end date. Results During the study period, there were 3834 first fractures following the index date and 3303 fractures in the 6month period prior to the diagnosis/treatment of osteoporosis. Incidence rates of osteoporosis-related fracture, estimated from the index date onward, increased with age, although did not significantly differ from one another in younger age groups (30–49 and 50–64 years). Spine fractures had the A. D. Manthripragada (*) : C. D. O’Malley : R. B. Wagman Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA 91320, USA e-mail: [email protected] U. Gruntmanis Division of Endocrinology, University of Texas, Southwestern Medical Center, Dallas, TX, USA J. W. Hall Ardea Biosciences, San Diego, CA, USA P. D. Miller Colorado Center for Bone Research, University of Colorado Health Sciences Center, Lakewood, CO, USA
highest incidence rate in men across all age groups, increasing from 10.8 per 100,000 person-years (p-yrs) (95 % confidence interval (CI) 9.1, 12.7), 12.2 per 100,000 p-yrs (95 % CI 11.2, 13.3), and 15.3 per 100,000 p-yrs (95 % CI 13.8, 16.9) in men 30–49, 50–64, and 65–74 years to 33.4 per 100,000 p-yrs (95 % CI 31.5, 35.4) in men ≥75 years. Hip fractures were the second most common, with the incidence rate reaching 16.2 per 100,000 (95 % CI 14.9, 17.6) in the ≥75-year group. Conclusion These incidence rates suggest that spine and hip fractures are a considerable disease burden for men of all ages diagnosed and/or treated for osteoporosis. Keywords Epidemiology . Fracture . Male . Osteoporosis . Trauma
Introduction Often perceived as a disease of women, osteoporosis is also a major disease of men. As in women, osteoporosis in men is defined as a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration leading to increased bone fragility [1]. Osteoporosis is frequently underdiagnosed and undertreated in men [2, 3]. Osteoporosis in men is associated with a significant fracture burden and related mortality. Of an estimated worldwide annual incidence of approximately 9 million osteoporosisrelated fractures in persons ≥50 years, 30 % of hip fractures, 20 % of forearm fractures, 42 % of clinical vertebral fractures, and 25 % of humerus fractures occurred in men, for a total of nearly 3.5 million fractures in men [4]. The lifetime risk of an osteoporosis-related fracture in men has been reported to be between 13 and 22 % [5]. Both short- and long-term mortality are associated with low-trauma fractures in men [6], with the
1620
1-year mortality after a hip fracture nearly two times higher for men than for women [7–9]. Additionally, men have a significantly worse functional outcome following hip fracture than women [10]. Although previous studies have estimated the incidence of fractures in older men with osteoporosis, the epidemiology of osteoporotic fractures in younger men is relatively unstudied [11]. Several studies have described the prevalence of osteoporosis (defined either by a low-trauma fracture or bone mineral density (BMD) criteria) in young men, but these studies do not examine osteoporosis-related fracture incidence rates, perhaps because of small sample size, nor do they present data allowing for the calculation of fracture incidence rates in osteoporotic young men [12–16]. Moreover, fracture incidence reports in younger men typically do not indicate whether subjects are diagnosed with osteoporosis. The aims of this study were to describe a cohort of men with presumed osteoporosis, identified by osteoporosis diagnoses or pharmacologic treatment claims, and to estimate the incidence rates of a variety of fractures in this cohort. We addressed the dearth of information on osteoporosis-related fractures among younger men with presumed osteoporosis by including men as young as 30 years of age in our study. Since studies report the prevalence of osteoporosis in men
