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OSTEOPOROSIS IN MEN
Tuan Van Nguyen and Nguyen Dinh Nguyen
Garvan Institute of Medical Research
Sydney, Australia
Background
Generally unrecognized 20 yrs ago.
An important public health problem.
30% of osteoporotic fractures occur in men.
Skeleton development
Peak bone mass closely tied to pubertal development.
Male-female differences in the skeleton appear during adolescence.
Peak bone mass achieved somewhat later in boys than girls.
Trabecular bone: boys=girls
Cortical bone: boys > girls
The reasons for sex difference in skeleton development unclear, but could be related to sex steroid action.
Prevalence of Osteoporosis
US, men 50y+: 3% to 6% (vs. 13-18% in women) (NHANES III, 1984-1994).
Canada, men 50y+: 2.9% at the lumbar spine and 4.8% at the femoral neck. (2001)
By the year 2020:
Osteoporosis: 3.3 million Men
Osteopenia: 17.1 million Men
Causes of Osteoporosis in Men
Primary:
Aging
Idiopathic:
unknown aetiology, possibly genetic factors
more common in young men
Secondary
Secondary Osteoporosis in Men
Hypogonadism
Glucocorticoid excess
Alcoholism, tobacco abuse
Renal insufficiency
Gastrointestinal, hepatic disorders, malabsorption
Hyperparathyroidism
Hypercalciuria
Anticonvulsants
Thyrotoxicosis
Chronic respiratory disorders
Anaemias, hemoglobinpathies
Immobilization
Osteoporosis imperfecta (OI)
Homocystinuria
Systemic mastocytosis
Neoplastic diseases
Rheumatoid arthritis

Osteoporotic fracture in Men
Lower incidence rates compared to women.
30% of osteoporotic fractures occur in men.
Increased with advancing age.
Increased with lower BMD.
BMD-independent factors involved.
Greater post-fracture mortality compared to those without fracture.
Incidence of fracture in Men
(Reproduced from Sander et al., 1999)
Incidence of Hip fracture in Men
Incidence of Vertebral fracture in Men
(Adapted from The EPOS Groups, 2002)
Incidence of Wrist fracture in Men
(Reproduced from Melton et al., 1998)
Incidence of other fractures
Risk factors for fracture in Men
Independent risk factors for any fracture in Men
(Source: Nguyen TV et al., Am J Epidemiol, 1996;114:255-63)

Risk factors for Hip fracture

(Source: Nguyen ND et al., JBMR, 2005)
Risk factors for incident Vert-fx
(Source: van de Klift M et al., JBMR 2004;19:1172-80)
Evaluation BMD in Men
Guidelines for the evaluation of osteoporosis in men not well validated.
Whether use T-scores based on a male-specific reference range or by using the same reference range used in women has been controversial.
 Currently use a male-specific reference range is suggested.
Indication for BMD testing
Men 50y+ who have suffered a fracture including those with vertebral deformity.
Younger men who suffer low trauma fractures.
Men with secondary causes of bone loss, including men treated with glucocorticoids or other medications associated with osteoporosis.
Laboratory testing
Serum Ca, P, Creatinine, ALK, WBC.
Liver function tests.
Protein electrophoresis in those >50y.
Serum 25(OH) vitamin D and PTH.
Serum testosterone and liteinizing hormone.
24h urine calcium and creatinine
Targeted diagnostic testing in men with signs, symptoms, or other indications of secondary disorders.
Osteoporosis prevention in Men
Similar to those in women
Excellent nutrition and exercise
Lifestyle
Calcium and Vitamin D supplementations
Increasing strength and balance
Early identifying causes of secondary osteoporosis
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