Skip to main content

Advertisement

SpringerLink
Log in

Osteoporosis in men: the value of laboratory testing

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

Evaluation of 234 men referred for osteoporosis found many with undiagnosed secondary causes and multiple unrecognized risk factors.

Introduction

Studies in women with postmenopausal osteoporosis suggest that many have unrecognized disorders affecting bone. Men are considered more likely to have underlying, possibly correctable causes. We studied the prevalence of risk factors, secondary causes, and laboratory abnormalities in men with and without previously known causes for osteoporosis.

Methods

We reviewed the charts of 234 men with osteoporosis diagnosed by bone mineral density testing. In addition to screening chemistries, 25-hydroxyvitamin D, testosterone, luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, and spot urinary calcium-to-creatinine ratio were measured.

Results

The mean age was 70.6 years and mean weight was 76.4 kg. The mean T-score for spine, femoral neck, and forearm was −2.2, −2.4, and −2.3, respectively. Evaluation revealed secondary osteoporosis in 75% overall including hypogonadism, vitamin D deficiency, hypercalciuria, subclinical hyperthyroidism, and hyperparathyroidism. In those men with known secondary osteoporosis at the time of dual energy X-ray absorptiometry testing, additional diagnoses were found in just over half. Vitamin D deficiency and insufficiency were very common, and other common risk factors for osteoporosis included age >65, current smoking, and prior fracture. Half of the subjects had ≥4 risk factors.

Conclusion

Evaluation revealed a specific cause in about half of men thought to have primary osteoporosis. Among men with known secondary osteoporosis, additional risk factors and secondary causes were frequently identified. In conclusion, a relatively modest evaluation of men with osteoporosis will often provide useful information.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Jones G, Nguyen T, Sambrook PN, Kelly PJ, Gilbert C, Eisman JA (1994) Symptomatic fracture incidence in elderly men and women: the Dubbo Osteoporosis Epidemiology Study (DOES). Osteoporos Int 4:277–282

    Article  PubMed  CAS  Google Scholar 

  2. Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ III (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005

    PubMed  CAS  Google Scholar 

  3. Sernbo I, Johnell O (1993) Consequences of a hip fracture: a prospective study over 1 year. Osteoporos Int 3:148–153

    Article  PubMed  CAS  Google Scholar 

  4. Kelepouris N, Harper KD, Gannon F, Kaplan FS, Haddad JG (1995) Severe osteoporosis in men. Ann Intern Med 123:452–460

    PubMed  CAS  Google Scholar 

  5. Caplan GA, Scane AC, Francis RM (1994) Pathogenesis of vertebral crush fractures in women. J R Soc Med 87:200–202

    PubMed  CAS  Google Scholar 

  6. Hanley DA, Brown JP, Tenenhouse A, Olszynski WP, Ioannidis G, Berger C, Prior JC, Pickard L, Murray RM, Anastassiades T, Kirkland S, Joyce C, Joseph L, Papaioannou A, Jackson SA, Poliquin S, Adachi JD, Canadian Multicentre Osteoporosis Study Research Group (2003) Association among disease conditions, bone mineral density, and prevalent vertebral deformities in men and women 50 years of age and older: cross-sectional results from the Canadian Multicentre Osteoporosis Study. J Bone Miner Res 18:784–790

    Article  PubMed  CAS  Google Scholar 

  7. Tannenbaum C, Clark J, Schwartzman K, Wallenstein S, Lapinski R, Meier D, Luckey M (2002) Yield of laboratory testing to identify secondary contributors to osteoporosis in otherwise healthy women. J Clin Endocrinol Metab 87:4431–4437

    Article  PubMed  CAS  Google Scholar 

  8. Adler RA, Tran MT, Petkov VI (2003) Performance of the osteoporosis self-assessment screening tool for osteoporosis in American men. Mayo Clin Proc 78:723–727

    Article  PubMed  Google Scholar 

  9. Wiliams MI, Petkov VI, Biskobing DM, Adler RA (2004) The Osteoporosis Self-Assessment Tool (OST) leads to increased osteoporosis evaluation and therapy in men. American Society for Bone and Mineral Research Annual Meeting, #SU-482 (abstract)

  10. Simonelli C, Adler RA, Blake GM, Caudill JP, Khan A, Leib E, Maricic M, Prior JC, Eis SR, Rosen C, Kendler DL (2008) Dual-energy X-ray absorptiometry technical issues: the 2007 ISCD official positions. J Clin Densitom 11:109–122

    Article  PubMed  Google Scholar 

  11. Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Forciea MA, Owens DK, Clinical Efficacy Assessment Subcommittee of the American College of Physicians (2008) Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians. Ann Intern Med 148:680–684

    PubMed  Google Scholar 

  12. Baillie SP, Davison CE, Johnson FJ, Francis RM (1992) Pathogenesis of vertebral crush fractures in men. Age Ageing 21:139–141

    Article  PubMed  CAS  Google Scholar 

  13. Pye SR, Adams KR, Halsey JP, Klimiuk P, Knight SM, Pal B, Selby PL, Stewart IM, Swinson DR, O’Neill TW (2003) Frequency and causes of osteoporosis in men. Rheumatology (Oxford) 42:811–812

    Article  CAS  Google Scholar 

  14. Evans SF, Davie MW (2000) Vertebral fractures and bone mineral density in idiopathic, secondary and corticosteroid associated osteoporosis in men. Ann Rheum Dis 59:269–275

    Article  PubMed  CAS  Google Scholar 

  15. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R (2005) Estimates of optimal vitamin D status. Osteoporos Int 16:713–716

    Article  PubMed  CAS  Google Scholar 

  16. Dawson-Hughes B, Mithal A, Bonjour JP, Boonen S, Burckhardt P, Fuleihan GE, Josse RG, Lips P, Morales-Torres J, Yoshimura N (2010) IOF position statement: vitamin D recommendations for older adults. Osteoporosis Int 21:1151–1154

    Article  CAS  Google Scholar 

  17. Luckey MM, Tannenbaum C (2003) Authors’ response: recommended testing in patients with low bone density. J Clin Endocrinol Metab 88:1405

    Article  CAS  Google Scholar 

  18. Binkley N, Krueger D, Cowgill CS, Plum L, Lake E, Hansen KE, DeLuca HF, Drezner MK (2004) Assay variation confounds the diagnosis of hypovitaminosis D: a call for standardization. J Clin Endocrinol Metab 89:3152–3157

    Article  PubMed  CAS  Google Scholar 

  19. Levis S, Gomez A, Jimenez C, Veras L, Ma F, Lai S, Hollis B, Roos BA (2005) Vitamin D deficiency and seasonal variation in an adult South Florida population. J Clin Endocrinol Metab 90:1557–1562

    Article  PubMed  CAS  Google Scholar 

  20. Binkley N, Novotny R, Krueger D, Kawahara T, Daida YG, Lensmeyer G, Hollis BW, Drezner MK (2007) Low vitamin D status despite abundant sun exposure. J Clin Endocrinol Metab 92:2130–2135

    Article  PubMed  CAS  Google Scholar 

  21. Kumari M, Judd SE, Tangpricha V (2008) Vitamin D status in United States war veterans. Endocr Pract 14:127–128

    PubMed  Google Scholar 

  22. Peris P, Guanabens N, Monegal A, Suris X, Alvarez L, Martinez de Osaba MJ, Hernandez MV, Munoz-Gomez J (1995) Aetiology and presenting symptoms in male osteoporosis. Br J Rheumatol 34:936–941

    Article  PubMed  CAS  Google Scholar 

  23. Perry HM III, Fallon MD, Bergfeld M, Teitelbaum SL, Avioli LV (1982) Osteoporosis in young men: a syndrome of hypercalciuria and accelerated bone turnover. Arch Intern Med 142:1295–1298

    Article  PubMed  Google Scholar 

  24. Pak CY, Kaplan R, Bone H, Townsend J, Waters O (1975) A simple test for the diagnosis of absorptive, resorptive and renal hypercalciurias. N Engl J Med 292:497–500

    Article  PubMed  CAS  Google Scholar 

  25. Stanley HL, Schmitt BP, Poses RM, Deiss WP (1991) Does hypogonadism contribute to the occurrence of a minimal trauma hip fracture in elderly men? J Am Geriatr Soc 39:766–771

    PubMed  CAS  Google Scholar 

  26. Abbasi AA, Rudman D, Wilson CR, Drinka PJ, Basu SN, Mattson DE, Richardson TJ (1995) Observations on nursing home residents with a history of hip fracture. Am J Med Sci 310:229–234

    PubMed  CAS  Google Scholar 

  27. Wang C, Neischlag E, Swerdloff R, Behre HM, Hellstrom WJ, Gooren LJ, Kaufman JM, Legros J-J, Lunenfeld B, Morales A, Morley JE, Schulman C, Thompson IM, Weidner W, Wu FCW (2009) Investigation, treatment, and monitoring of late-onset hypogonadism in males; ISA, ISSAM, EAU, EAA, and ASA recommendations. J Androl 30:1–9

    Article  PubMed  Google Scholar 

  28. Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR (2001) Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab 86:724–731

    Article  PubMed  CAS  Google Scholar 

  29. Snyder PJ, Peachey H, Hannoush P, Berlin JA, Loh L, Holmes JH, Diewati A, Santanna RCJ, Strom BL (1999) Effect of testosterone treatment on bone mineral density in men over 65 years of age. J Clin Endocrinol Metab 84:1966–1972

    Article  PubMed  CAS  Google Scholar 

  30. Snyder PJ (2004) Hypogonadism in elderly men—what to do until the evidence comes. N Engl J Med 350:440–442

    Article  PubMed  CAS  Google Scholar 

  31. Kaufman JM, Vermeulen A (2005) The decline of androgen levels in elderly men and its clinical and therapeutic implications. Endocr Rev 26:833–876

    Article  PubMed  CAS  Google Scholar 

  32. Kelleher S, Conway AJ, Handelsman DJ (2004) Blood testosterone threshold for androgen deficiency syndromes. J Clin Endocrinol Metab 89:2813–3817

    Article  Google Scholar 

  33. Koh LK, Sedrine WB, Torralba TP, Kung A, Fujiwara S, Chan SP, Huang QR, Rajatanavin R, Tsai KS, Park HM, Reginster JY, Osteoporosis Self-Assessment Tool for Asians (OSTA) Research Group (2001) A simple tool to identify Asian women at increased risk of osteoporosis. Osteoporos Int 12:699–705

    Article  PubMed  CAS  Google Scholar 

  34. Edwards BJ, Langman CB, Bunta AD, Vicuna M, Favus M (2008) Secondary contributors to bone loss in osteoporosis related hip fractures. Osteoporos Int 19:991–999

    Article  PubMed  CAS  Google Scholar 

  35. Dumitrescu B, van Helden S, ten Broeke R, Nieuwenhuijzen-Kruseman A, Wyers C, Udrea G, van der Linden S, Geusens P (2008) Evaluation of patients with a recent clinical fracture and osteoporosis, a multidisciplinary approach. BMC Musculoskelet Disord 9:109

    Article  PubMed  Google Scholar 

  36. Johnson SL, Petkov VI, Williams MI, Via PS, Adler RA (2005) Improving osteoporosis management in patients with fractures. Osteoporos Int 16:1079–1085

    Article  PubMed  CAS  Google Scholar 

  37. Papaioannu A, Kennedy CC, Cranney A, Hawker G, Brown JP, Kaiser SM, Leslie WD, O’Brien CJM, Sawka AM, Khan A, Siminoski K, Tarulli G, Webster D, McGowan J, Adachi JD (2009) Risk factors for low BMD in healthy men age 50 years or older: a systematic review. Osteoporos Int 20:507–518

    Article  Google Scholar 

  38. Thomas-John M, Codd MB, Manne S, Watts NB, Mongey AB (2009) Risk factors for the development of osteoporosis and osteoporotic fractures among older men. J Rheumatol 36:1947–1952

    Article  PubMed  Google Scholar 

  39. Trimpou P, Landin-Wilhelmsen K, Oden A, Rosengren A, Wilhelmsen L (2010) Male risk factors for hip fracture—a 30-year follow-up study in 7, 495 men. Osteoporos Int 21:409–416

    Article  PubMed  Google Scholar 

  40. Adler RA (1992) Clinical review 33: clinically important effects of alcohol on endocrine function. J Clin Endocrinol Metab 74:957–960

    Article  PubMed  CAS  Google Scholar 

  41. Felson DT, Kiel DP, Anderson JJ, Kannel WB (1988) Alcohol consumption and hip fractures: the Framingham Study. Am J Epidemiol 128:1102–1110

    PubMed  CAS  Google Scholar 

  42. Poor G, Atkinson EJ, O’Fallon WM, Melton LJ III (1995) Predictors of hip fractures in elderly men. J Bone Miner Res 10:1900–1907

    Article  PubMed  CAS  Google Scholar 

  43. Kanis JA, Oden A, Johansson H, Borgstrom F, Strom O, McCloskey E (2009) FRAX® and its application to clinical practice. Bone 44:734–743

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

RAA has received research support from Genentech, Novartis, Eli Lilly, Amgen, and Merck and is a consultant for Eli Lilly, Merck, and GTX, Inc. CSR and VIP have indicated they have nothing to disclose.

Author information

Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA

    C. S. Ryan & R. A. Adler

  2. Endocrinology Section, McGuire Veterans Affairs Medical Center, 1201 Broad Rock Blvd, Richmond, VA, USA

    C. S. Ryan & R. A. Adler

  3. McGuire Research Institute, Richmond, VA, USA

    V. I. Petkov & R. A. Adler

Authors
  1. C. S. Ryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. I. Petkov
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. A. Adler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. A. Adler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ryan, C.S., Petkov, V.I. & Adler, R.A. Osteoporosis in men: the value of laboratory testing. Osteoporos Int 22, 1845–1853 (2011). https://doi.org/10.1007/s00198-010-1421-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-010-1421-0

Keywords

Search

Navigation