RESEARCH presented at the World Congress on Osteoporosis (WCO) suggests that men may be undergoing bone density screening too late to fully benefit from treatment, raising concerns about missed opportunities in osteoporosis care.
In an analysis of individuals born between 1900 and 1960, investigators examined outcomes following a first dual-energy X-ray absorptiometry (DXA) scan, focusing on survival and mortality patterns compared with the general population.
Marked Survival Gap Between Men and Women
The study included over 72,000 men and 172,000 women undergoing their first DXA scan, matched to background populations. Despite similar average ages at the time of scanning, outcomes diverged significantly.
Five-year survival after DXA was notably lower in men at 73%, compared to 87% in women. The gap widened further at 10 years, with survival falling to just 52% in men versus 71% in women.
Higher Excess Mortality in Men
Men also showed substantially higher excess mortality relative to the general population. Standardised mortality ratios were 56% higher in men compared to controls, versus a 17% increase observed in women.
This is particularly striking given that women in the study were more likely to present with osteoporosis-level bone density (T-score < -2.5) and recent major osteoporotic fractures.
Missed Window for Treatment Benefit
The researchers set out to assess whether DXA scans are being performed early enough to allow for at least five years of treatment benefit. The findings suggest that, in men, this window may often already be closing by the time of first assessment.
Shorter survival after DXA limits the opportunity for interventions such as anti-osteoporotic therapies to meaningfully reduce fracture risk.
A Persistent Gap in Male Osteoporosis Care
The data point to a broader issue: osteoporosis remains under-recognised and underdiagnosed in men. While screening and referral pathways are well established for women, particularly post-menopause, men are less likely to be assessed proactively.
As a result, they may only be referred once comorbidities accumulate or health declines, reducing the potential impact of treatment.
Rethinking Referral Strategies
The findings highlight the need for earlier identification of at-risk men and a shift in how osteoporosis is approached across sexes.
If screening continues to occur late in the disease trajectory, particularly in men, the clinical benefits of diagnosis may be significantly diminished—turning what should be a preventive intervention into a reactive one.
Reference
Bakke Hansen B et al. Life Expectancy Following First DXA – Are Men Referred Too Late? An Analysis of the 1900–1960 Birth Cohort. Abstract OC2. WCO-IOF-ESCEO, 16–19th April.
