Osteoporosis in Men

Abstract

With the aging of the population, there is a growing recognition that osteoporosis and fractures in men are a significant public health problem, and both hip and vertebral fractures are associated with increased morbidity and mortality in men. Osteoporosis in men is a heterogeneous clinical entity: whereas most men experience bone loss with aging, some men develop osteoporosis at a relatively young age, often for unexplained reasons (idiopathic osteoporosis). Declining sex steroid levels and other hormonal changes likely contribute to age-related bone loss, as do impairments in osteoblast number and/or activity. Secondary causes of osteoporosis also play a significant role in pathogenesis. Although there is ongoing controversy regarding whether osteoporosis in men should be diagnosed based on female- or male-specific reference ranges (because some evidence indicates that the risk of fracture is similar in women and men for a given level of bone mineral density), a diagnosis of osteoporosis in men is generally made based on male-specific reference ranges. Treatment consists both of nonpharmacological (lifestyle factors, calcium and vitamin D supplementation) and pharmacological (most commonly bisphosphonates or PTH) approaches, with efficacy similar to that seen in women. Increasing awareness of osteoporosis in men among physicians and the lay public is critical for the prevention of fractures in our aging male population.

Using the same bone density reference database for men and women provides a simpler estimation of fracture risk

“…(11)(12)(13) These two sets of observations are often presented as in conflict. (14) A recent review by Khosla and colleagues (15) concluded that the most appropriate definition for osteoporosis in men, in the absence of fractures, was a major unresolved issue and should be the focus of future research. This issue was specifically addressed in the population-based Canadian Multicentre Osteoporosis Study (CaMOS) cohort, one of the first population-based cohorts to include both men and women.…”

Osteoporosis in Men - A Crucial Role of Sex Hormones

“…These properties, or bone 'qualities', are compromised with the emergence of age-related abnormalities in bone modelling and remodelling, the cellular machinery responsible for the attainment of peak bone strength during growth and its maintenance during adulthood. The abnormalities contributing to material and structural decay are: a negative bone balance produced by each basic multicellular unit (BMU), a sustained increase in remodelling intensity in midlife in women but not in men unless frankly hypogonadal, reduced periosteal apposition after completion of longitudinal growth and secondary hyperparathyroidism (Khosla et al 2006). However, the most important cause of bone loss is the increase in the intensity of bone remodelling on the trabecular, intracortical and endocortical bone surfaces (Amin & Felson 2001;Benito et al 2004).…”

“…Men with a deficiency of total testosterone were more likely to have rapid bone loss from the hip or to suffer from hip fractures following minimal trauma. Also men with osteoporosis were more likely to have a deficiency of testosterone and estradiol (Khosla et al 2006). …”

“…Advancing age is associated with a reduction in osteonal size, accompanied by an increase in haversian canal diameter due to the reduced bone formation by each BMU. Smaller osteons result in less resistance to crack propagation through interstitial bone (Khosla et al 2006). Also, smaller osteons give rise to a greater proportion interstitial (rather than osteonal) bone which has a higher tissue mineralization density, fewer osteocytes and is liable to accumulate microdamage and offer less resistance to crack propagation.…”

Male osteoporosis: A review

“…In a recent study about men and women who had suffered a hip fracture, the effectiveness of zoledronic acid was evaluated by means of the health-related quality of life, demonstrating a significant improvement of their functional scores [116] . Although there are not as many studies on the use of bisphosphonates in men as there are in women, some authors claim that their effectiveness is similar in both genders [117] . Finally, in prostate cancer patients treated with androgenic deprivation and presenting a strong BMD decrease, bisphosphonates have been proved as an effective therapy for bone loss [118,119] .…”