Osteoporosis assessment strategies for male nursing home residents

Objectives: Twenty-five to thirty percent of hip fractures occur in men, and nursing home residents have a 5–10-fold greater fracture risk than community-dwellers. Osteoporosis prevalence in men in long-term care, however, is poorly defined. Our objectives were to determine the prevalence of osteoporosis, as assessed by peripheral bone mineral density (BMD), in a group of institutionalized veterans, and to determine how many men with low BMD had received a prior diagnosis of osteoporosis. Methods: Subjects were residents in a 740-bed skilled nursing facility (78% men). Male residents (n=103) competent to give informed consent underwent bilateral calcaneal and forearm BMD by dual-energy X-ray absorptiometry (DXA). Prior osteoporosis documentation was sought in medical records. Results: Twenty percent of veterans (95% confidence interval (CI) 12–28%) exhibited calcaneal osteoporosis (T-score < −2.5), and 62% (CI 52–72%) were osteoporotic at the forearm. Forearm and calcaneal BMD were correlated (r=0.678, P<0.001). BMD of the left and right forearm, and of left and right calcaneus, were highly correlated (r=0.880, P<0.001 and r=0.931, P<0.001, respectively). Documentation of osteoporosis existed for one of 20 men with calcaneal osteoporosis and four of 59 men with forearm osteoporosis. Conclusions: Osteoporosis was prevalent but poorly documented in institutionalized veterans. Discordance in T-scores between forearm and heel was similar to that reported in other studies. The broad range of T-scores among subjects suggests that peripheral BMD measurement may be useful for clinical fracture risk stratification. Correlation among skeletal sites indicates that measuring a single site may be practical.