{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:31:22Z","timestamp":1785537082471,"version":"3.56.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T00:00:00Z","timestamp":1718064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 AR074958"],"award-info":[{"award-number":["R01 AR074958"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Randomized trials have not been performed, and may never be, to determine if osteoporosis treatment prevents hip fracture in men. Addressing that evidence gap, we analyzed data from an observational study of new hip fractures in a large integrated healthcare system to compare the reduction in hip fractures associated with standard-of-care osteoporosis treatment in men versus women. Sampling from 271,389 patients aged\u2009\u2265\u200965 who had a hip-containing CT scan during care between 2005 and 2018, we selected all who subsequently had a first hip fracture (cases) after the CT scan (start of observation) and a sex-matched equal number of randomly selected patients. From those, we analyzed all who tested positive for osteoporosis (DXA-equivalent hip BMD T-score\u2009\u2264\u2009\u22122.5, measured from the CT scan using VirtuOst). We defined \u201ctreated\u201d as at least six months of any osteoporosis medication by prescription fill data during follow-up; \u201cnot-treated\u201d was no prescription fill. Sex-specific odds ratios of hip fracture for treated vs not-treated patients were calculated by logistic regression; adjustments included age, BMD T-score, BMD-treatment interaction, BMD, race\/ethnicity, and seven baseline clinical risk factors. At two-year follow-up, 33.9% of the women (750\/2,211 patients) and 24.0% of the men (175\/728 patients) were treated primarily with alendronate; 51.3% and 66.3%, respectively, were not-treated; and 721 and 269, respectively, had a first hip fracture since the CT scan. Odds ratio of hip fracture for treated vs not-treated was 0.26 (95% confidence interval: 0.21\u20130.33) for women and 0.21 (0.13\u20130.34) for men; the ratio of these odds ratios (men:women) was 0.81 (0.47\u20131.37), indicating no significant sex effect. Various sensitivity and stratified analyses confirmed these trends, including results at five-year follow-up. Given these results and considering the relevant literature, we conclude that osteoporosis treatment prevents hip fracture similarly in both sexes.<\/jats:p>","DOI":"10.1093\/jbmr\/zjae090","type":"journal-article","created":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T21:56:37Z","timestamp":1718056597000},"page":"1424-1433","source":"Crossref","is-referenced-by-count":17,"title":["Osteoporosis treatment prevents hip fracture similarly in both sexes: the FOCUS observational study"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0258-7178","authenticated-orcid":false,"given":"Tony M","family":"Keaveny","sequence":"first","affiliation":[{"name":"Departments of Mechanical Engineering and Bioengineering, University of California , Berkeley, CA 94720,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7338-4808","authenticated-orcid":false,"given":"Annette L","family":"Adams","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California , Pasadena, CA 91101,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8520-7355","authenticated-orcid":false,"given":"Eric S","family":"Orwoll","sequence":"additional","affiliation":[{"name":"Bone and Mineral Unit, Oregon Health & Science University , Portland, OR 97239,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2936-4372","authenticated-orcid":false,"given":"Sundeep","family":"Khosla","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Kogod Center on Aging, Mayo Clinic , Rochester, MN 55905,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9736-3451","authenticated-orcid":false,"given":"Ethel S","family":"Siris","sequence":"additional","affiliation":[{"name":"Department of Medicine, Toni Stabile Osteoporosis Center, Columbia University Medical Center , New York, NY 10032,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7827-0778","authenticated-orcid":false,"given":"Michael R","family":"McClung","sequence":"additional","affiliation":[{"name":"Oregon Osteoporosis Center , Portland, OR 97225,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7027-7414","authenticated-orcid":false,"given":"Mary L","family":"Bouxsein","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery , Harvard Medical School, , Boston, MA 02215,","place":["United States"]},{"name":"Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center , Harvard Medical School, , Boston, MA 02215,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shireen","family":"Fatemi","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Kaiser Permanente Southern California , Panorama City, CA 91402,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4486-331X","authenticated-orcid":false,"given":"David C","family":"Lee","sequence":"additional","affiliation":[{"name":"O.N. Diagnostics LLC , Berkeley, CA 94704,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6127-5145","authenticated-orcid":false,"given":"David L","family":"Kopperdahl","sequence":"additional","affiliation":[{"name":"O.N. Diagnostics LLC , Berkeley, CA 94704,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,6,11]]},"reference":[{"issue":"3","key":"2024092612105668700_ref1","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1359\/jbmr.061113","article-title":"Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025","volume":"22","author":"Burge","year":"2007","journal-title":"J Bone Miner Res"},{"issue":"2","key":"2024092612105668700_ref2","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.jamda.2007.10.001","article-title":"A national perspective of Medicare expenditures for elderly veterans with hip fractures","volume":"9","author":"Bass","year":"2008","journal-title":"J Am Med Dir Assoc"},{"issue":"7","key":"2024092612105668700_ref3","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1016\/j.annepidem.2006.12.004","article-title":"Risk-adjusted mortality rates of elderly veterans with hip fractures","volume":"17","author":"Bass","year":"2007","journal-title":"Ann Epidemiol"},{"issue":"3","key":"2024092612105668700_ref4","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1056\/NEJMcp1513724","article-title":"Clinical practice. Postmenopausal osteoporosis","volume":"374","author":"Black","year":"2016","journal-title":"N Engl J Med"},{"issue":"3","key":"2024092612105668700_ref5","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1111\/jgs.14668","article-title":"Osteoporosis treatment efficacy for men: a systematic review and meta-analysis","volume":"65","author":"Nayak","year":"2017","journal-title":"J Am Geriatr Soc"},{"issue":"24","key":"2024092612105668700_ref6","doi-asserted-by":"crossref","first-page":"2521","DOI":"10.1001\/jama.2018.7498","article-title":"Screening for osteoporosis to prevent fractures: US preventive services task force recommendation statement","volume":"319","author":"U. S. Preventive Services Task Force","year":"2018","journal-title":"JAMA"},{"issue":"8","key":"2024092612105668700_ref7","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1016\/S2213-8587(20)30159-5","article-title":"Treatment-related changes in bone mineral density as a surrogate biomarker for fracture risk reduction: meta-regression analyses of individual patient data from multiple randomised controlled trials","volume":"8","author":"Black","year":"2020","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"2","key":"2024092612105668700_ref8","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1007\/s00774-023-01407-0","article-title":"Efficacy of anti-osteoporosis treatment for men with osteoporosis: a meta-analysis","volume":"41","author":"Dong","year":"2023","journal-title":"J Bone Miner Metab"},{"issue":"4","key":"2024092612105668700_ref9","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1359\/jbmr.081214","article-title":"Once-weekly risedronate in men with osteoporosis: results of a 2-year, placebo-controlled, double-blind, multicenter study","volume":"24","author":"Boonen","year":"2009","journal-title":"J Bone Miner Res"},{"issue":"9","key":"2024092612105668700_ref10","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1056\/NEJM200008313430902","article-title":"Alendronate for the treatment of osteoporosis in men","volume":"343","author":"Orwoll","year":"2000","journal-title":"N Engl J Med"},{"issue":"10","key":"2024092612105668700_ref11","doi-asserted-by":"crossref","first-page":"2239","DOI":"10.1002\/jbmr.119","article-title":"Efficacy and safety of a once-yearly IV infusion of zoledronic acid 5\u2009mg versus a once-weekly 70-mg oral alendronate in the treatment of male osteoporosis: a randomized, multicenter, double-blind, active-controlled study","volume":"25","author":"Orwoll","year":"2010","journal-title":"J Bone Miner Res"},{"issue":"4","key":"2024092612105668700_ref12","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/j.bone.2009.12.034","article-title":"Efficacy and safety of monthly ibandronate in men with low bone density","volume":"46","author":"Orwoll","year":"2010","journal-title":"Bone"},{"issue":"18","key":"2024092612105668700_ref13","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.1056\/NEJMoa067312","article-title":"Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis","volume":"356","author":"Black","year":"2007","journal-title":"N Engl J Med"},{"issue":"1","key":"2024092612105668700_ref14","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s001980050010","article-title":"Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral efficacy with risedronate therapy (VERT) study group","volume":"11","author":"Reginster","year":"2000","journal-title":"Osteoporos Int"},{"issue":"22","key":"2024092612105668700_ref15","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1056\/NEJM199511303332201","article-title":"Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis","volume":"333","author":"Liberman","year":"1995","journal-title":"N Engl J Med"},{"issue":"18","key":"2024092612105668700_ref16","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1056\/NEJMoa1204061","article-title":"Fracture risk and zoledronic acid therapy in men with osteoporosis","volume":"367","author":"Boonen","year":"2012","journal-title":"N Engl J Med"},{"issue":"7","key":"2024092612105668700_ref17","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1002\/jbmr.3423","article-title":"Osteoporosis and hip fracture risk from routine computed tomography scans: the fracture, osteoporosis, and CT utilization study (FOCUS)","volume":"33","author":"Adams","year":"2018","journal-title":"J Bone Miner Res"},{"issue":"Suppl 3","key":"2024092612105668700_ref18","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s00198-011-1712-0","article-title":"Fracture prevention in Kaiser Permanente Southern California","volume":"22","author":"Dell","year":"2011","journal-title":"Osteoporos Int"},{"issue":"Supplement_6","key":"2024092612105668700_ref19","doi-asserted-by":"crossref","first-page":"79","DOI":"10.2106\/JBJS.I.00521","article-title":"Osteoporosis disease management: what every orthopaedic surgeon should know","volume":"91","author":"Dell","year":"2009","journal-title":"J Bone Joint Surg Am"},{"issue":"5","key":"2024092612105668700_ref20","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1359\/jbmr.091033","article-title":"Age-dependence of femoral strength in white women and men","volume":"25","author":"Keaveny","year":"2010","journal-title":"J Bone Miner Res"},{"issue":"3","key":"2024092612105668700_ref21","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1002\/jbmr.2069","article-title":"Assessment of incident spine and hip fractures in women and men using finite element analysis of CT scans","volume":"29","author":"Kopperdahl","year":"2014","journal-title":"J Bone Miner Res"},{"issue":"3","key":"2024092612105668700_ref22","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1038\/ajg.2013.478","article-title":"Validation of a CT-derived method for osteoporosis screening in IBD patients undergoing contrast-enhanced CT enterography","volume":"109","author":"Weber","year":"2014","journal-title":"Am J Gastroenterol"},{"issue":"1","key":"2024092612105668700_ref23","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1148\/radiol.2015141984","article-title":"Comprehensive assessment of osteoporosis and bone fragility with CT colonography","volume":"278","author":"Fidler","year":"2016","journal-title":"Radiology"},{"key":"2024092612105668700_ref24","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.bone.2017.07.029","article-title":"Phantomless calibration of CT scans for measurement of BMD and bone strength \u2014 inter-operator reanalysis precision","volume":"103","author":"Lee","year":"2017","journal-title":"Bone"},{"issue":"6","key":"2024092612105668700_ref25","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1007\/s00198-020-05384-2","article-title":"Biomechanical computed tomography analysis (BCT) for clinical assessment of osteoporosis","volume":"31","author":"Keaveny","year":"2020","journal-title":"Osteoporos Int"},{"issue":"3","key":"2024092612105668700_ref26","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.jocd.2015.06.011","article-title":"Clinical use of quantitative computed tomography-based finite element analysis of the hip and spine in the management of osteoporosis in adults: the 2015 ISCD official positions-part II","volume":"18","author":"Zysset","year":"2015","journal-title":"J Clin Densitom"},{"issue":"7382","key":"2024092612105668700_ref27","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1136\/bmj.326.7382.219","article-title":"Interaction revisited: the difference between two estimates","volume":"326","author":"Altman","year":"2003","journal-title":"BMJ"},{"issue":"6","key":"2024092612105668700_ref28","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1002\/jbmr.3411","article-title":"Management of patients with high baseline hip fracture risk by FRAX reduces hip fractures-a post hoc analysis of the SCOOP study","volume":"33","author":"McCloskey","year":"2018","journal-title":"J Bone Miner Res"},{"issue":"24","key":"2024092612105668700_ref29","doi-asserted-by":"crossref","first-page":"2077","DOI":"10.1001\/jama.280.24.2077","article-title":"Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the fracture intervention trial","volume":"280","author":"Cummings","year":"1998","journal-title":"JAMA"},{"issue":"7","key":"2024092612105668700_ref30","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.1002\/jbmr.1606","article-title":"Denosumab reduces the risk of osteoporotic fractures in postmenopausal women, particularly in those with moderate to high fracture risk as assessed with FRAX","volume":"27","author":"McCloskey","year":"2012","journal-title":"J Bone Miner Res"},{"issue":"11","key":"2024092612105668700_ref31","doi-asserted-by":"crossref","first-page":"4118","DOI":"10.1210\/jcem.85.11.6953","article-title":"Fracture risk reduction with alendronate in women with osteoporosis: the fracture intervention trial. FIT Research Group","volume":"85","author":"Black","year":"2000","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"2024092612105668700_ref32","doi-asserted-by":"crossref","first-page":"224","DOI":"10.7326\/M22-1034","article-title":"Pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults: a living clinical guideline from the American College of Physicians","volume":"176","author":"Qaseem","year":"2023","journal-title":"Ann Intern Med"},{"issue":"9","key":"2024092612105668700_ref33","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1007\/s40520-023-02478-9","article-title":"Efficacy of osteoporosis pharmacological treatments in men: a systematic review and meta-analysis","volume":"35","author":"Beaudart","year":"2023","journal-title":"Aging Clin Exp Res"}],"container-title":["Journal of Bone and Mineral Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jbmr\/advance-article-pdf\/doi\/10.1093\/jbmr\/zjae090\/58468089\/zjae090.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmr\/advance-article-pdf\/doi\/10.1093\/jbmr\/zjae090\/59350948\/zjae090.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmr\/advance-article-pdf\/doi\/10.1093\/jbmr\/zjae090\/59350948\/zjae090.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,26]],"date-time":"2024-09-26T12:11:19Z","timestamp":1727352679000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbmr\/article\/39\/10\/1424\/7691181"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,11]]},"references-count":33,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,6,11]]},"published-print":{"date-parts":[[2024,9,26]]}},"URL":"https:\/\/doi.org\/10.1093\/jbmr\/zjae090","relation":{},"ISSN":["0884-0431","1523-4681"],"issn-type":[{"value":"0884-0431","type":"print"},{"value":"1523-4681","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,10]]},"published":{"date-parts":[[2024,6,11]]}}}