Screening men

for osteoporosis I have many middle-aged and elderly men in my family practice, including some who are being treated for osteo-porosis, and thus I read with interest the CMAJ article on managing osteo-porosis in men by Aliya Khan and col-leagues.1 I was surprised by the au-thors ’ statement that “as in the 2002 guidelines [from the Osteoporosis So-ciety of Canada], [bone mineral test-ing] for all men over 65 is advised.” The article did not provide any evi-dence to support this recommendation, so I turned to the cited guidelines.2 The first sentence in the section on osteo-porosis in men states that “there are in-sufficient data on the relation between [bone mineral density] and fracture risk in men. ” Neither the guidelines nor the article by Khan and colleagues provides information on the incidence of osteoporosis in men. It would seem to me that any further discussion should be postponed until such data are available. However, both docu-ments go on to recommend screening for men over 65 years of age. How can one propose screening for a disease when the incidence of the condition is unknown in the popula-tion in question and when use of the recommended screening tool cannot as yet be correlated with disease detec-tion? Furthermore, no evidence was provided concerning the cost of screen-ing, the number of cases of osteoporo-sis that would be diagnosed by screen-ing all men (rather than only men at high risk of developing the disease) and the number of subsequent frac-tures that would be prevented by screening