Bone Mineral Density and Vertebral Fractures in Men

Abstract

In women, many studies indicate that the risk of vertebral fragility fractures increases as bone mineral density (BMD) declines. In contrast, few studies are available for BMD and vertebral fractures in men. It is uncertain that the strength of the relationship between BMD and fractures is similar in magnitude in middle-aged men and in postmenopausal women. In the present study, 200 men (mean age 54.7 years) with lumbar osteopenia (T-score < -1.5) were recruited to examine the relationships between spine BMD and hip BMD and the associations of BMD with vertebral fractures. Lumbar BMD was assessed from L2 to L4, in the anteroposterior view, using dual-energy X-ray densitometry. At the upper left femur, hip BMD was measured at five regions of interest: femoral neck, trochanter, intertrochanter, Ward's triangle and total hip. Spinal radiographs were analyzed independently by two trained investigators and vertebral fracture was defined as a reduction of at least 20% in the anterior, middle or posterior vertebral height. Spinal radiographs evidenced at least one vertebral crush fracture in 119 patients (59.5%). The results of logistic regression showed that age, femoral and spine BMDs were significant predictors of the presence of a vertebral fracture. Odds ratios for a decrease of 1 standard deviation ranged from 1.8 (1.3-2.8) for spine BMD to 2.3 (1.5-3.6) for total hip BMD. For multiple fractures odds ratios ranged from 1.7 (1.1-2.5) for spine BMD to 2.6 (1.7-4.3) for total hip BMD. In all models, odds ratios were higher for hip BMD than for spine BMD, particularly in younger men, under 50 years. A T-score < -2.5 in the femur (total femoral site) was associated with a 2.7-fold increase in the risk of vertebral fracture while a T-score < -2.5 in the spine was associated with only a 2-fold increase in risk. This study confirms the strong association of age and BMD with vertebral fractures in middle-aged men, shows that the femoral area is the best site of BMD measurement and suggests that a low femoral BMD could be considered as an index of severity in young men with lumbar osteopenia.

Identification of Vertebral Fracture and Non-Osteoporotic Short Vertebral Height in Men: The MrOS Study

“…(26,27) In some studies, the increased prevalence with age was more marked for men with multiple fractures (16,25) : we found no evidence of this in MrOS (data not shown). The absent age association in the MrOS study may reflect the healthy volunteer effect: the oldest men participating in MrOS may be healthier compared with their peers in the general population, which would lead to underestimation of vertebral fracture prevalence in this group.…”

Cross-sectional analysis of the association between fragility fractures and bone microarchitecture in older men: The STRAMBO study

“…(15,29,30) Patients with severe or multiple vertebral fractures have lower aBMD values than those with mild or one fracture. (31,32) In postmenopausal women, more severe vertebral fractures were related to poorer bone microarchitecture assessed by HR-pQCT or bone histomorphometry. (15,19) Similar association for bone microarchitecture assessed by bone histomorphometry was found in osteoporotic men.…”

Treatment of Male Osteoporosis: Recent Advances with Alendronate

“…This relationship has been well established in postmenopausal women [16][17][18][19][20] and there is now a growing body of data showing a similar relationship in men [21][22][23][24][25][26][27][28][29][30][31]. Other risk factors for osteoporotic fractures are important in both women and men, including low body mass [26,[32][33][34][35], smoking [32,36,37], excessive alcohol intake [32,37,38], physical inactivity [32,37] and falls [35,37].…”