Personal non-commercial use only. The Journal of Rheumatology. Copyright © 2004. All rights reserved Sawka, et al: OP in Canadian men 1993 The CANDOO database has been sponsored in part by Procter and Gamble Pharmaceuticals. From McMaster University, St. Joseph’s Healthcare, Centre for Evaluation of Medicines, Hamilton, and the University of Toronto, Toronto, Ontario; the University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier de Laval, and McGill University, Montreal, Quebec; and the University of Calgary, Calgary, Alberta, Canada. A.M. Sawka, MD; J.D. Adachi, MD; A. Papaioannou, MD; L. Thabane, PhD, McMaster University, St. Joseph’s Healthcare, Centre for Evaluation of Medicines; G. Ioannidis, MSc, St. Joseph’s Healthcare; K.S. Davison, PhD, McMaster University; W.P. Olszynski, MD, University of Saskatchewan; J.P. Brown, MD, Centre Hospitalier de Laval; D.A. Hanley, MD, University of Calgary; T.M. Murray, MD; R.G. Josse, MD, University of Toronto; R.J. Sebaldt, MD; A. Petrie, McMaster University, St. Joseph’s Healthcare; A. Tenenhouse, MD, McGill University; C.H. Goldsmith, PhD, McMaster University, St. Joseph’s Healthcare, Centre for Evaluation of Medicines. Address reprint requests to Dr. J.D. Adachi, 501-25 Charlton Avenue East, Hamilton, Ontario, L8N 1Y2. Submitted December 1, 2003; revision accepted April 28, 2004. Osteoporosis is an important source of morbidity and mortality in men. Approximately 20-30% of all hip fractures occur in men 1-3 . Furthermore, men have an age-adjusted prevalence of vertebral fractures similar to women 4 . Moreover, bisphosphonates have been shown to increase bone mineral density (BMD) at the spine and hip and prevent vertebral fractures in men with osteoporosis 5-7 . Despite this, men are less likely to be treated with a bisphos- phonate after hip fracture than women 8 . We compared men and women referred to Canadian specialty osteoporosis practices and prescribed bisphosphonates. MATERIALS AND METHODS We studied 1588 patients (163 men, 1425 women), 50 years of age and older, who were prescribed cyclic etidronate or alendronate and had at least 2 years of followup registered in the Canadian Database for Osteoporosis and Osteopenia Patients (CANDOO) Study. The CANDOO study is a collaborative, prospective observational program in which data are collected systematically from routine clinical care by a network of tertiary care specialists in osteoporosis 9 . Further methodologic information about the CANDOO database has been published 9 . Participating study centers included McMaster University, McGill University, Centre Hospitalier de Laval, University of Calgary, University of Saskatchewan, and the University of Toronto. Choice of treatment was at the discretion of the treating physician. Typically, etidronate disodium was prescribed at a dose of 400 mg daily for 14 days, followed by 76 days of calcium carbonate (500 mg of elemental calcium) (Didrocal ® , Procter and Gamble), and alen- dronate was prescribed at a dose of 10 mg daily (Fosamax ® , Merck Frosst). All patients were encouraged to consume 1000 mg of elemental calcium and 400-1000 IU of vitamin D daily. Patients were excluded from this study if they were receiving concurrent therapy with one of the above bisphos- Are There Differences Between Men and Women Prescribed Bisphosphonate Therapy in Canadian Subspecialty Osteoporosis Practices? ANNA M. SAWKA, JONATHAN D. ADACHI, ALEXANDRA PAPAIOANNOU, LEHANATHABANE, GEORGE IOANNIDIS, K. SHAWN DAVISON, WOJCIECH P. OLSZYNSKI, JACQUES P. BROWN, DAVID A. HANLEY, TIM M. MURRAY, ROBERTG. JOSSE, ROLF J. SEBALDT, ANNIE PETRIE, ALAN TENENHOUSE, and CHARLES H. GOLDSMITH ABSTRACT. Objective. To determine if there are differences between men and women referred for treatment of osteoporosis in Canada. Methods. We performed an observational study of 1588 patients (163 men, 1425 women), 50 years of age and older, who were prescribed cyclic etidronate or alendronate for treatment of osteoporosis or osteopenia and had at least 2 years of followup registered in the Canadian Database for Osteoporosis and Osteopenia Patients (CANDOO). Comparisons of characteristics between men and women were performed using Pearson chi-square test, Student’s t test, or a Kruskal-Wallis test, whichever was most appropriate. Results. Mean baseline femoral neck and lumbar spine bone mineral densities were significantly higher in men than women at both the femoral neck and lumbar spine (p < 0.05, respectively). Men had double the rate of prevalent vertebral fractures (44%, 72/163) compared to women (22%, 315/1425; p < 0.001) and triple the rate of multiple prevalent vertebral fractures (10%, 17/163) compared to women (3%, 37/1425, p < 0.001). Furthermore, men were twice as likely as women to sustain a fracture within 2 years of starting treatment during observation in the CANDOO study (men: 4%, 7/163, women: 2%, 24/1425, p = 0.033). Conclusion. Osteoporosis may be under-recognized in men until the condition is at an advanced stage. A form of gender bias may exist in recognition and treatment (or referral for treatment) of osteoporosis in men. (J Rheumatol 2004;31:1993–5) Key Indexing Terms: OSTEOPOROSIS FRACTURES GENDER DIPHOSPHONATES Personal, non-commercial use only. The Journal of Rheumatology. Copyright © 2004. All rights reserved. www.jrheum.org Downloaded on January 22, 2022 from