MON-786 - Underrecognized Vertebral Compression Fractures in Hospitalized Men: A Real-World Study of Osteoporosis Evaluation, Treatment, and Outcomes after Incidental Atraumatic Fracture Detection

Title
Underrecognized Vertebral Compression Fractures in Hospitalized Men: A Real-World Study of Osteoporosis Evaluation and Outcomes
Background
Vertebral compression fractures in men are often underrecognized as manifestations of osteoporosis, particularly when discovered incidentally during hospitalization. Real-world data on osteoporosis evaluation, endocrine workup, treatment, and outcomes in this population are limited.
Methods
We conducted a retrospective real-world cohort study of adult men admitted to a single health system who had vertebral compression fractures identified on inpatient imaging. Of 127 hospitalized men identified with compression fractures, 62 had atraumatic, painless fractures and were included. We assessed post-hospitalization outpatient osteoporosis care, including diagnostic testing (DXA scanning, vitamin D measurement, and laboratory assessment for secondary causes), osteoporosis-related treatments, and clinical outcomes. Outcomes included 30-day and 1-year mortality, 30-day readmission, and incident refracture. Analyses were primarily descriptive, with exploratory univariable analyses.
Results
All included patients (100%) had atraumatic vertebral compression fractures. Fractures were predominantly lumbar (50.0%) or thoracic (41.9%). DXA scanning was ordered in 27.4% and completed in 24.2% of patients. Vitamin D levels were measured in 54.8%, with abnormalities identified in 32.4% of those tested. Laboratory evaluation included calcium in 98.4%, phosphate in 83.9%, parathyroid hormone in 32.3%, and testosterone in 21.0%. Among those tested, abnormalities were common, including parathyroid hormone abnormalities in 50.0% and abnormal testosterone levels in 69.2%. Only 3.2% completed a full secondary osteoporosis evaluation. Vitamin D and calcium supplementation were prescribed in 41.9% and 29.0% of patients, respectively, while pharmacologic osteoporosis therapy was initiated in only 4.8% within 6 months. Outcomes included a 30-day mortality rate of 1.6%, 1-year mortality of 11.3%, 30-day readmission of 25.8%, and incident refracture of 14.5%. Chronic kidney disease or end-stage renal disease was significantly associated with increased 1-year mortality (P = 0.003).
Conclusions
In this real world cohort of hospitalized men with incidentally identified atraumatic vertebral compression fractures, post-discharge osteoporosis evaluation and treatment were infrequently performed, despite frequent secondary endocrine abnormalities and substantial adverse outcomes. These findings highlight a major care gap and support the development of standardized post-discharge pathways, including DXA ordering and endocrinology referral to improve osteoporosis care in men.

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