Résumé
La maladie ostéoporotique est un problème de santé publique pris en compte depuis une trentaine d’années chez la femme. Elle est traitée comme un risque au cours des sixième et septième décennies et comme une fatalité chez les sujets âgés. L’allongement progressif de l’espérance de vie a fait émerger la nécessité de prendre en considération les conséquences vitales et fonctionnelles des fractures ostéoporotiques des hommes de plus de 80 ans. L’ostéoporose contribue au processus de fragilisation qui conduit à la dépendance en association avec les autres problèmes de santé publique que sont les maladies cardiovasculaires et les démences. Un ensemble cohérent de données épidémiologiques montre que les courbes d’incidence de l’ostéoporose augmentent exponentiellement avec l’âge dans les deux sexes mais sont retardées d’une dizaine d’années chez les hommes. La démonstration de la réduction de la mortalité liée à un traitement par l’acide zolédronique après une fracture de hanche est venue conforter l’intérêt d’un traitement anti-ostéoporotique actif chez les sujets âgés des deux sexes. En milieu gériatrique, la problématique de la prise en charge du risque ostéoporotique chez l’homme se décline de trois façons: 1) la conduite à tenir devant une fracture incidente qui est souvent l’expression itérative de la maladie ostéoporotique; 2) la découverte de séquelles radiologiques de fractures antérieures, particulièrement de fractures vertébrales décrites sur une radiographie du thorax demandée pour un autre motif; 3) une masse osseuse basse densitométrique qui est souvent la règle au col du fémur dans cette tranche de population. L’évaluation du rapport coût/bénéfice des traitements de l’ostéoporose doit être pondérée par l’appréciation de l’espérance de vie probable et par les limitations d’observance imposées par une polymédicamentation souvent extensive.
Abstract
Since the first publication by Albright in 1941, osteoporosis has been widely considered as a female problem of public health. The regular increase of life expectancy has shown the rise of male osteoporosis especially in the population over 80 years old. The primary goal of treatment is to delay the fracture cascade that leads to fragility process and organic dependence. In geriatric practices, aging male osteoporosis may be considered in three ways: 1) evolutionary osteoporosis with incident fracture; 2) incidental diagnosis of vertebral fracture; 3) diagnosis of low bone mass that is highly prevalent in this population. The choice of the right treatment must be balanced by the analysis of cost/effectiveness ratio based on probable life expectancy and on polymedication very common in aging men.
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Weryha, G., Weryha, B., Rancier, M. et al. L’ostéoporose chez l’homme âgé. cah. année gerontol. 1, 188–194 (2009). https://doi.org/10.1007/s12612-009-0028-6
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DOI: https://doi.org/10.1007/s12612-009-0028-6