Osteoporosis in men

Abstract

Osteoporosis is defined as "a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture". Approximately 40-50% of women sustain osteoporotic fractures in their lifetime; as such, it is appropriate that studies initially focused upon females. Despite an increased recognition of osteoporotic fractures in men, there continues to be neglect of this disease in males. This ongoing neglect is inappropriate as 25-33% of men in some populations will sustain osteoporotic fractures in their lifetime. Testosterone plays an important role in male skeletal health. However, recent data suggest that estrogen may in fact be the dominant hormone regulating skeletal status in both men and women. BMD measurement may be utilized for osteoporosis diagnosis and to assist with fracture risk prediction in men prior to their sustaining a fracture. Recognizing this need, the International Society for Clinical Densitometry (ISCD) recommended and recently reaffirmed use of a BMD T-score of -2.5 or below be utilized to diagnose osteoporosis in men. Androgen therapy of hypogonadal men may be considered with the caveat that data do not exist to document that this treatment reduces fracture risk. At this time, the data is inadequate to support use of androgen treatment in eugonadal men with osteoporosis. Parathyroid hormone treatment does increase BMD; existing studies have not been of adequate size or duration to document fracture reduction efficacy. Bisphosphonate therapy increases BMD, reduces vertebral fracture risk and is considered the standard of care for osteoporotic men at this point in time. RESUMO Osteoporose em Homens.A osteoporose é definida como "uma doença esquelética sistêmica caracterizada por baixa massa óssea e deterioração da microarquitetura do tecido ósseo com conseqüente aumento da susceptibilidade a fraturas". Aproximadamente 40-50% das mulheres apresentarão uma fratura osteoporótica durante suas vidas, e por isso os estudos iniciais focalizaram o sexo feminino. A despeito do reconhecimento cada vez mais freqüente da ocorrência de fraturas osteoporóticas em homens, a doença continua sendo negligenciada no sexo masculino. Isto não é apropriado na medida em que 25-33% dos homens em algumas populações apresentarão fraturas osteoporóticas durante suas vidas. A testosterona exerce um importante papel na integridade esquelética masculina, contudo dados recentes sugerem que os estrógenos são de fato os hormônios dominantes na regulação esquelética em ambos os sexos. A medida da densidade mineral óssea pode ser utilizada no diagnóstico e para avaliar o risco de fraturas, e a ISCD recomenda que o escore T de -2.5 ou menos seja usado como critério diagnóstico no homem. A terapia androgênica no hipogonadismo masculino deve ser original articleOsteoporosis in Men

Efficacy and safety of a once-yearly i.v. Infusion of zoledronic acid 5 mg versus a once-weekly 70-mg oral alendronate in the treatment of male osteoporosis: A randomized, multicenter, double-blind, active-controlled study

“…(1)(2)(3) Although fractures are more common in women, 25% to 33% of men are likely to sustain osteoporotic fractures during their lifetime, (4) and the morbidity and mortality associated with osteoporotic fractures are higher in men than in women. (5) Despite the importance of osteoporosis in men, few adequately powered trials with pharmacologic therapy have been performed, and thus the available information on treatment options in men is limited.…”

The art of treating osteoporosis: Bisphosphonates

“…В развитых странах 20% всех кли-нически выявленных переломов позвоночника, 25% пере-ломов костей предплечья и 30% переломов бедренной кости регистрируются у мужчин [27]. Особенность мужского ОП -очень высокая доля (по разным данным, от 30 до 60% [28]) вторичных причин заболевания, поэтому перед принятием решения о лечении у мужчин важно тщательно проанализи-ровать и попытаться устранить все факторы, которые могли повлиять на развитие ОП.…”

Mortality in Proximal Femur Fractures in an Old-Age Group of Kemerovo as a Rationale for the Necessityof Medical Prevention of Osteoporosis

“…Она зависит от характера лечебных мероприятий, ослож-нений и продолжительности пребывания в лечебном учреж-дении. По данным ряда исследований, показатели больнич-ной летальности колеблются от 3 до 14% и в среднем состав-ляют 3% среди женщин и 8% среди мужчин [5][6][7].…”

“…Определенное значение у пациентов с переломом бедра имеют методы лечения и реабилитация [2,4,7]. Консерва-тивная тактика ведения способствует длительной иммоби-лизации больных и как следствие -низкому качеству жиз-ни и высокой летальности от сопутствующей патологии.…”