Current Rheumatology Reports

, Volume 3, Issue 3, pp 240–244

Osteoporosis in men: Are we ready to diagnose and treat?

  • Horace M. PerryIII
  • John E. Morley
Article

Abstract

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

  1. 1.
    Melton LJ III, Atkinson EJ, O’Connor MK, et al.: Bone density and fracture risk in men. J Bone Miner Res 1998, 13:1915–1923. An epidemiologic study in men looking at various diagnostic criteria for osteoporosis and relative risk for fracture.PubMedCrossRefGoogle Scholar
  2. 2.
    Baron JA, Karagas M, Barrett J, et al.: Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology 1996, 7:612–618.PubMedCrossRefGoogle Scholar
  3. 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
  4. 4.
    Riggs BL, Wahner HW, Seeman E, et al.: Changes in bone mineral density of the proximal femur and spine with aging. J Clin Invest 1982, 70:716–723.PubMedGoogle Scholar
  5. 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. 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
  7. 7.
    Faulkner KG, Cummings SR, Black D, et al.: Simple measurement of femoral geometry predicts hip fracture: the study of osteoporotic fractures. J Bone Miner Res 1993, 8:1211–1217.PubMedCrossRefGoogle Scholar
  8. 8.
    Mussolino ME, Looker AC, Madans JH, Langlois JA, Orwoll ES:Risk factors for hip fracture in white men: the NHANES I epidemiologic follow-up study. J Bone Miner Res 1998, 13:918–924.PubMedCrossRefGoogle Scholar
  9. 9.
    Melton LJ, Kan SH, Wahner HW, Riggs K: Lifetime fracture risk: an approach to hip fracture risk assessment based on bone mineral density and age. J Clin Epidemiol 1988, 41:985–994.PubMedCrossRefGoogle Scholar
  10. 10.
    Schwartz RS: Sarcopenia and physical performance in old age: introduction. Muscle Nerve 1997, 5:S10-S12.PubMedCrossRefGoogle Scholar
  11. 11.
    Dutta C, Hadley EC, Lexell J: Sarcopenia and physical performance in old age: overview. Muscle Nerve 1997, 5:S5-S9.PubMedCrossRefGoogle Scholar
  12. 12.
    Birge SJ: Can falls and hip fracture be prevented in frail older adults? JAGS 1999, 47:1265–1266.Google Scholar
  13. 13.
    Newman A: Cognitive performance and estrogen use in nondemented older women. JAGS 1999, 47:1267–1268.Google Scholar
  14. 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. 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
  16. 16.
    Perry HM III, Morley JE, Horowitz M, et al.: Body composition and age in African-American and Caucasian women: relationship to plasma leptin levels. Metabolism 1997, 46:1399–1405.PubMedCrossRefGoogle Scholar
  17. 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
  18. 18.
    Evans W: Functional and metabolic consequences of sarcopenia. J Nutr 1997, 127:998S-1003S.PubMedGoogle Scholar
  19. 19.
    Jette AM, Branch LG: The Framingham disability study: II physical disability among the aging. Am J Public Health 1981, 71:1211.PubMedGoogle Scholar
  20. 20.
    Cummings SR, Kelsey JL, Nevitt MC, et al.: Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985, 7:178–208.PubMedGoogle Scholar
  21. 21.
    Morley JE, Kaiser FE, Perry III HM, et al.: Longitudinal changes in testosterone, luteinizing hormone, and follicle stimulating hormone in healthy older men. Metab Clin Exp 1997, 46:410–413.PubMedGoogle Scholar
  22. 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
  23. 23.
    Mooradian AD, Morley JE, Korenman SG: Biological actions of androgens. Endocrin Rev 1987, 8:1–28.CrossRefGoogle Scholar
  24. 24.
    Perry HM III, Horowitz M, Morley JE, et al.: Longitudinal changes in serum 25 hydroxyvitamin D in older people. Metabolism 1999, 48:1028–1032.PubMedCrossRefGoogle Scholar
  25. 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
  26. 26.
    Perry HM III, Miller DK, Patrick P, Morley JE: Testosterone and leptin in older African-American men: relationship to age, strength, function and season. Metabolism 2000, 49:1085–1091.PubMedCrossRefGoogle Scholar
  27. 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
  28. 28.
    Slemenda CW, Longcope C, Zhou L, et al.: Sex steroids and bone mass in older men: positive associations with serum estrogens and negative associations with androgens. J Clin Invest 1997, 100:1755–1759.PubMedCrossRefGoogle Scholar
  29. 29.
    Amin S, Zhang Y, Sawin CT, et al.: Association of hypogonadism and estradiol levels with bone mineral density in elderly men from the Framingham Study. Ann Intern Med 2000, 133:951–963.PubMedGoogle Scholar
  30. 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
  31. 31.
    Jackson JA, Riggs MW, Spiekerman AM: Testosterone deficiency as a risk factor for hip fractures in men: a case control study. Am J Med Sci 1992, 304:4–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Morley JE, Perry HM III, Kaiser FE, et al.: Effects of testosterone replacement therapy in old hypogonadal males: a preliminary study. J Am Geriatr Soc 1993, 41:149–152.PubMedGoogle Scholar
  33. 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. 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
  35. 35.
    Tenover JS: Effects of testosterone supplementation in the aging male. J Clin Endocrinol Metab 1992, 75:1092–1098.PubMedCrossRefGoogle Scholar
  36. 36.
    Snyder PJ, Peachey H, Hannoush P, et al.: Effect of testosterone treatment on body composition and muscle strength in men over 65 years of age. J Clin Endocrinol Metab 1999, 84:2647–2653.PubMedCrossRefGoogle Scholar
  37. 37.
    Finkelstein JS, Klibanski A, Neer RM, et al.: Increases in bone density during treatment of men with idiopathic hypogonadotropic hypogonadism. J Clin Endocrinol Metab 1989, 69:776–783.PubMedCrossRefGoogle Scholar
  38. 38.
    Anderson FH, Francis RM, Peaston RT, Wastell HJ: Androgen supplementation in eugonadal men with osteoporosis: effects of six months’ treatment on markers of bone formation and resorption. J Bone Mineral Res 1997, 12:472–478.CrossRefGoogle Scholar
  39. 39.
    Kiel DP, Felson DT, Anderson JJ, Wilson PW, Moskowitz MA: Hip fracture and the use of estrogen in postmenopausal women. The Framingham Study. N Engl J Med 1987, 317:1169–74.PubMedCrossRefGoogle Scholar
  40. 40.
    Ensrud KE, Black DM, Palermo L, et al.: Treatment with alendronate prevents fractures in women at highest risk: results from the Fracture Intervention Trial. Arch Intern Med 1997, 157:2617–2624.PubMedCrossRefGoogle Scholar
  41. 41.
    Harris ST, Watts NB, Genant HK, et al.: Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 1999, 282:1344–1352.PubMedCrossRefGoogle Scholar
  42. 42.
    Chapuy MC, Arlot ME, Duboeuf F, et al.: Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 1992, 327:1637–1642.PubMedCrossRefGoogle Scholar
  43. 43.
    Lips P, Graafmans WC, Ooms ME, Bezemer PD, Bouter LM: Vitamin D supplementation and fracture incidence in elderly persons: a randomized, placebo-controlled clinical trial. Ann Intern Med 1996, 124:400–406.PubMedGoogle Scholar
  44. 44.
    Kanis JA, McCloskey EV: Effect of calcitonin on vertebral and other fractures. QJM 1999, 92:143–149.PubMedCrossRefGoogle Scholar
  45. 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
  46. 46.
    The Coronary Drug Project Research Group: The coronary drug project: findings leading to discontinuation of the 25-mg/day estrogen group. JAMA 1973, 226:652–657.CrossRefGoogle Scholar
  47. 47.
    Delmas PD, Bjarnason NH, Mitlak BH, et al.: Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med 1997, 337:1641–1647.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • Horace M. PerryIII
    • 1
  • John E. Morley
    • 1
  1. 1.Division of GeriatricsSt. Louis VA Medical CenterSt. LouisUSA

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