Screening men for osteoporosis

I have many middle-aged and elderly men in my family practice, including some who are being treated for osteoporosis, and thus I read with interest the CMAJ article on managing osteoporosis in men by Aliya Khan and colleagues.¹ I was surprised by the authors' statement that “as in the 2002 guidelines [from the Osteoporosis Society of Canada], [bone mineral testing] for all men over 65 is advised.”

The article did not provide any evidence to support this recommendation, so I turned to the cited guidelines.² The first sentence in the section on osteoporosis in men states that “there are insufficient data on the relation between [bone mineral density] and fracture risk in men.” Neither the guidelines nor the article by Khan and colleagues provides information on the incidence of osteoporosis in men. It would seem to me that any further discussion should be postponed until such data are available. However, both documents go on to recommend screening for men over 65 years of age.

How can one propose screening for a disease when the incidence of the condition is unknown in the population in question and when use of the recommended screening tool cannot as yet be correlated with disease detection? Furthermore, no evidence was provided concerning the cost of screening, the number of cases of osteoporosis that would be diagnosed by screening all men (rather than only men at high risk of developing the disease) and the number of subsequent fractures that would be prevented by screening.