Risk factors for low BMD in healthy men age 50 years or older: a systematic review
In this systematic review, we summarize risk factors for low bone mineral density and bone loss in healthy men age 50 years or older. Consistent risk factors were: age, smoking, low weight, physical/functional limitations, and previous fracture. Data specific to men has clinical and policy implications.
Osteoporosis is a significant health care problem in men as well as women, yet the majority of evidence on diagnosis and management of osteoporosis is focused on postmenopausal women. The objective of this systematic review is to examine risk factors for low bone mineral density (BMD) and bone loss in healthy men age 50 years or older.
Materials and methods
A systematic search for observational studies was conducted in MEDLINE, Cochrane Database of Systematic Reviews, DARE, CENTRAL, CINAHL and Embase, Health STAR. The three main search concepts were bone density, densitometry, and risk factors. Trained reviewers assessed articles using a priori criteria.
Of 642 screened abstracts, 299 articles required a full review, and 25 remained in the final assessment. Consistent risk factors for low BMD/bone loss were: advancing age, smoking, and low weight/weight loss. Although less evidence was available, physical/functional limitations and prevalent fracture (after age 50) were also associated with low BMD/bone loss. The evidence was inconsistent or weak for physical activity, alcohol consumption, calcium intake, muscle strength, family history of fracture/osteoporosis, and height/height loss.
In this systematic review, we identified several risk factors for low BMD/bone loss in men that are measurable in primary practice.
KeywordsBone density DXA Men Osteoporosis Risk factors Systematic review
We thank Chistina Lachetti, Kristina Szabo, and Nicole Zytaruk for data abstraction, and Lois Wyndham for literature review and library assistance.
This project was funded by the Ontario Ministry of Health and Long-Term Care, Ontario Osteoporosis Strategy.
Conflicts of interest
Alexandra Papaioannou, MD, FRCPC, MSc
Consulting and Advisory Role: Amgen, Eli Lilly, Merck Frosst, Novartis, Proctor & Gamble, Sanofi-aventis, Servier
Clinical Trials: Amgen, Eli Lilly, Merck, Novartis, Proctor & Gamble, Sanofi-aventis
Ann Cranney, MD, FRCPC, MSc has received honoraria for educational lectures from Merck Frosst, Alliance for Bone Health and Novartis; and consultant fees from Amgen Canada and Research funding from Hofmann La Roche.
Jacques P. Brown, MD, FRCPC has received honoraria for lecturing, consultancies, grants and research support for clinical trials: Abbott, Alpharx, Amgen, Arthrolab, Sanofi-aventis Canada, Boehringer Ingelheim/Roche, Bristol-Myers Squibb, Celltech, Eli Lilly Canada, Genizon, Glaxosmithkline, Merck Frosst, Nicox, Novartis, NPS Pharma, Pfizer, Proctor & Gamble, Quintiles, Rhône-Poulenc Rorer, Servier, Wyeth, Zelos.
Stephanie M Kaiser, MD, FRCPC
Advisory Boards: Amgen, Eli Lilly, Novartis, Wyeth-Ayerst, Servier
Speaker for: Amgen, Eli Lilly, Novartis, Merck, Procter & Gamble/Sanofi-aventis, AstraZeneca, Servier
William D. Leslie, MD, FRCPC, MSc
Speaker fees, research honoraria, and unrestricted research grants: Merck Frosst Canada Ltd; research honoraria and unrestricted educational grants from The Alliance for Better Bone Health: Sanofi-aventis and Procter & Gamble Pharmaceuticals Canada, Inc.; unrestricted research grants from Novartis Pharmaceuticals Canada, Inc.; unrestricted educational grants from Genzyme Canada
Consulting Role: Proctor & Gamble, Merck Frosst, Novartis
Research: Proctor & Gamble, Merck Frosst, Servier, Amgen, Eli Lilly
Jonathan D. Adachi, MD
Consulting Role: Amgen; Astra Zeneca, Eli Lilly; GlaxoSmithKline; Merck Frosst; Novartis; Proctor & Gamble; Roche; Sanofi-aventis; Servier
Clinical Trials: Eli Lilly; GlaxoSmithKline; Merck; Novartis; Pfizer; Proctor & Gamble; Sanofi-aventis; Servier; Wyeth-Ayerst
Courtney C. Kennedy, MSc; Gillian Hawker MD, MSc, FRCPC; Anna M. Sawka MD, FRCPC, PhD; Kerry Siminoski, MD, FRCPC; David Webster, MD, FRCP; Jessie McGowan MLIS: No competing interests to declare.
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