- Joined
- May 25, 2016
- Messages
- 16
- Reaction score
- 27
There has been much data published on indications for doing osteoporosis workup in females and is even required as a health screening measure in all the females of ages 65 or older. However, no such specific guidelines exist for older males and it is important to identify these candidates for DEXA scan as the pharmacological therapies can reverse and slow down the progression of this condition.
Who are candidates for doing a DEXA scan in males?
According to societies of National Osteoporosis Foundation (NOF), International Society for Clinical Densitometry (ISCD), and the Endocrine Society, every male older than 70 years old should get a DEXA scan. However, in clinical practice, this guideline (atleast in my experience) is not applied as rigorously as other widely accepted standards of practice. When do primary care doctors feel the need to order a DEXA scan in male?
-When the patient tells you he has history of fractures from low trauma or low impact (such as falling on the floor from the chair resulting in a hip fracture).
-When the patient has x-rays done for another reason (i.e- back pain) which incidentally shows signs of osteopenia. What are the radiographic signs of osteopenia: Decreased cortical thickness of the bone and loss of bony trabecula. For vertebral osteoporosis: compression fractures are a dead giveaway and in this particular instance, you have to think of multiple myeloma as an important differential!
-When the patient tells you that he is losing height of more than 1.5 inches
-When the patient is on long-term glucocorticoid therapy (greater than 5 mg of Prednisone > 3 months) for various conditions ranging from interstitial lung disease to Nephrotic syndrome.
-When the patient is deprived of androgens for prostate cancer therapy (pharmacological castration)
-When patient has a malabsorptive syndrome such as celiac disease causing Vitamin D deficiency or endocrinological disorder such as hyperparathyroidism
Conversely, when a new patient comes to you with a diagnosis of osteoporosis on a DEXA scan, the above conditions are the ones you have to work up to uncover the cause after gathering a good history and physical.
Now, for those of you who have made it this far and are wondering why Arnold Schwarzenegger out of all people may need a DEXA scan, there are few eccentric but insightful reasons. First of all, Arnold continues to work out with weights even at 70 years of age and weightlifting is the best way to prevent bone loss. Matter of fact, patients who are diagnosed with osteoporosis are strongly advised to take up weightlifting in order to strengthen the bones in addition to pharmacological therapy.
Could Arnold’s self-confessed steroid use during his bodybuilding days make him a candidate? That’s probably not the case as he participated in his last bodybuilding competition in 1980 and I doubt that he is continuing to use steroids now.
However, there is a fascinating reason which makes him a candidate for DEXA scan: Arnold during his prime was always listed as 6’2 in height. However, now routinely he is mentioned as being 5’11. Matter of fact, there is a webpage solely devoted to this issue!
The Ongoing Mystery of Arnold Schwarzenegger’s Actual Height
More importantly for us as physicians, could the greatest bodybuilder of all time have lost over 2 inches? Aging does shrink our bodies but Arnold looks physically fit at his age. The likely answer is probably not and just like many other celebrities in Hollywood, his stats were initially inflated. Nevertheless, it certainly makes the topic of screening for osteoporosis in males a much more interesting discussion.
I hope you enjoyed reading this topic and if you are interested in receiving weekly (or every other week- sometimes I do get busy seeing real patients :- )) emails of this nature, please go to learninginternalmed.com and subscribe! Thanks!
Who are candidates for doing a DEXA scan in males?
According to societies of National Osteoporosis Foundation (NOF), International Society for Clinical Densitometry (ISCD), and the Endocrine Society, every male older than 70 years old should get a DEXA scan. However, in clinical practice, this guideline (atleast in my experience) is not applied as rigorously as other widely accepted standards of practice. When do primary care doctors feel the need to order a DEXA scan in male?
-When the patient tells you he has history of fractures from low trauma or low impact (such as falling on the floor from the chair resulting in a hip fracture).
-When the patient has x-rays done for another reason (i.e- back pain) which incidentally shows signs of osteopenia. What are the radiographic signs of osteopenia: Decreased cortical thickness of the bone and loss of bony trabecula. For vertebral osteoporosis: compression fractures are a dead giveaway and in this particular instance, you have to think of multiple myeloma as an important differential!
-When the patient tells you that he is losing height of more than 1.5 inches
-When the patient is on long-term glucocorticoid therapy (greater than 5 mg of Prednisone > 3 months) for various conditions ranging from interstitial lung disease to Nephrotic syndrome.
-When the patient is deprived of androgens for prostate cancer therapy (pharmacological castration)
-When patient has a malabsorptive syndrome such as celiac disease causing Vitamin D deficiency or endocrinological disorder such as hyperparathyroidism
Conversely, when a new patient comes to you with a diagnosis of osteoporosis on a DEXA scan, the above conditions are the ones you have to work up to uncover the cause after gathering a good history and physical.
Now, for those of you who have made it this far and are wondering why Arnold Schwarzenegger out of all people may need a DEXA scan, there are few eccentric but insightful reasons. First of all, Arnold continues to work out with weights even at 70 years of age and weightlifting is the best way to prevent bone loss. Matter of fact, patients who are diagnosed with osteoporosis are strongly advised to take up weightlifting in order to strengthen the bones in addition to pharmacological therapy.
Could Arnold’s self-confessed steroid use during his bodybuilding days make him a candidate? That’s probably not the case as he participated in his last bodybuilding competition in 1980 and I doubt that he is continuing to use steroids now.
However, there is a fascinating reason which makes him a candidate for DEXA scan: Arnold during his prime was always listed as 6’2 in height. However, now routinely he is mentioned as being 5’11. Matter of fact, there is a webpage solely devoted to this issue!
The Ongoing Mystery of Arnold Schwarzenegger’s Actual Height
More importantly for us as physicians, could the greatest bodybuilder of all time have lost over 2 inches? Aging does shrink our bodies but Arnold looks physically fit at his age. The likely answer is probably not and just like many other celebrities in Hollywood, his stats were initially inflated. Nevertheless, it certainly makes the topic of screening for osteoporosis in males a much more interesting discussion.
I hope you enjoyed reading this topic and if you are interested in receiving weekly (or every other week- sometimes I do get busy seeing real patients :- )) emails of this nature, please go to learninginternalmed.com and subscribe! Thanks!
