Osteoporosis in men: Are we ready to diagnose and treat?
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Because osteoporosis and its attendant fractures are more common in women than in men, most studies have been performed in women. However, age-related osteoporosis and fragility fractures are also a major problem in men. Recent studies suggest that diagnosing men as osteoporotic when they fall more than 2.5 standard deviations below the mean for young men identifies a group at risk for fracture. Data suggest that many men with femoral fractures have age-related hypogonadism. Hypogonadism is associated with decreased lean body mass and bone mass. Most men with femoral fractures are reported to be hypogonadal. Testosterone replacement in hypogonadal older men improves bone mass and lean body mass. A therapeutic intervention to reduce fracture incidence in men with osteoporosis has been reported. No population-based study has examined the incidence or prevalence of hypogonadism with or without osteoporosis in men. Thus, osteoporosis in men probably exists with and without hypogonadism. Therapeutic interventions should be based on treatment of hypogonadism when present with osteoporosis.
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References and Recommended Readings
- 3.Jacobsen SJ, Goldberg J, Miles TP, et al.: Hip fracture incidence among the old and very old: a population-based study of 745,435 cases. Am J Public Health 1994, 80:871–873.Google Scholar
- 5.Wishner JM, Need AJ, Horowitz M, Morris HA, Nordin BEC: Effect of age on bone density and bone turnover in men. Clin Endocrinol 1995, 42:141–146.Google Scholar
- 6.Heaney RP: Pathogenesis of postmenopausal osteoporosis. In Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, edn 3. Edited by Favus MJ. New York: Lippincott-Raven; 1996:252–256.Google Scholar
- 12.Birge SJ: Can falls and hip fracture be prevented in frail older adults? JAGS 1999, 47:1265–1266.Google Scholar
- 13.Newman A: Cognitive performance and estrogen use in nondemented older women. JAGS 1999, 47:1267–1268.Google Scholar
- 14.Brown M, Sinacore DR, Host HH: The relationship of strength to function in the older adult. J Gerontol 1995, 50A:55–59.Google Scholar
- 15.Morley JE, Kaiser F, Raum WJ, et al.: Potentially predictive and manipulable blood serum correlates of aging in the healthy human male: progressive decreases in bioavailable testosterone, dehydroepiandrosterone sulfate, and the ratio of insulin-like growth factor-1 to growth hormone. Proc Natl Acad Sci USA 1997, 94:7537–7542.PubMedCrossRefGoogle Scholar
- 17.Baumgartner RN, Waters DL, Gallagher D, Morley JE, Garry PJ: Predictors of skeletal muscle mass in elderly men and women. Mech Ageing Dev 1999, 107:123–136. A large study of endocrine predictors of muscle mass in older individuals. It is not population based and evaluates only healthy individuals. Still, it is the only large study of its type of which we are aware.PubMedCrossRefGoogle Scholar
- 22.Morley JE, Charlton E, Patrick P, et al.: Validation of a screening questionnaire for androgen deficiency in aging males (ADAM). Metabolism 2000, 49:1239–1242. A study describing a questionnaire to be used in an officebased practice setting. The questionnaire identifies men at risk for hypogonadism.PubMedCrossRefGoogle Scholar
- 25.Morley JE, Perry HM III, Baumgartner RP, Garry PJ: Commentary: leptin, adipose tissue and aging - Is there a role for testosterone? J Gerontol 1999, A54:B108-B109.Google Scholar
- 27.Vellas BJ, Wayne SJ, Garry PJ, Baumgartner RN: A two-year longitudinal study of falls in 482 community-dwelling elderly adults. J Gerontol A Biol Sci Med Sci 1998, 53A:M264–274. A large 2-year study of falls in healthy volunteers. The study examined the predictive value of a series of tests for falls. The tests may be performed without special equipment in the office.Google Scholar
- 30.Riggs BL, Khosla S, Melton LJ III: A unitary model for involutional osteoporosis: estrogen deficiency causes both type I and type II osteoporosis in postmenopausal women and contributes to bone loss in aging men. J Bone Miner Res 1998, 13:763–773. The authors propose a mechanism for the effect of estrogen on bone in men.PubMedCrossRefGoogle Scholar
- 33.Sih R, Morley JE, Kaiser FE, et al.: Testosterone replacement in older hypogonadal men: a 12 month randomized controlled trial. J Clin Endocrinol Metab 1997, 82:1661–1667.A small 1-year prospective study of testosterone replacement in hypogonadal men demonstrating improvement in strength in the treated subjects.PubMedCrossRefGoogle Scholar
- 34.Snyder PJ, Peachey H, Hannoush P, et al.: Effect of testosterone treatment on bone mineral density in men over 65 years of age. J Clin Endocrinol Metab 1999, 84:1966–1972. A large 3-year prospective trial of testosterone treatment to improve bone mass in men with low normal or low testosterone. Men with low normal testosterone did not improve bone mass. Hypogonadal older men showed improvement in lumbar bone mass.PubMedCrossRefGoogle Scholar
- 45.Orwoll E, Ettinger M, Weiss S, et al.: Alendronate for the treatment of osteoporosis in men. N Engl J Med 2000, 343:604–10.A small study (241 men) compared with other clinical studies of alendronate. The study demonstrates a statistically significant decrease in fractures in men treated with alendronate, probably without regard to gonadal status.PubMedCrossRefGoogle Scholar