Risk Factors for Osteoporotic Fractures in Elderly Men

Abstract

Osteoporosis is recognized as an important cause of morbidity and mortality in aging women, but there have been few epidemiologic studies in men. Potential risk factors for osteoporotic fractures were assessed in 220 elderly men aged 60 years or above in the city of Dubbo (Australia). During the follow-up period of 1989-1994, the overall incidence of fractures (determined from x-ray reports) was 220 fractures per 10,000 person-years. Higher risk of fracture was associated with lower femoral neck bone mineral density (BMD), quadriceps weakness, higher body sway, falls in the preceding 12 months, a history of fractures in the previous 5 years, lower body weight, and shorter current height. Use of thiazide diuretics, higher physical activity, and moderate alcohol intake were protective against fracture. In multivariate analysis (Cox's proportional hazards model), femoral neck BMD (odd ratio (OR) = 1.47, 95% confidence interval (CI) 1.25-1.73 per 0.12 g/cm2), quadriceps strength (OR = 1.43, 95% CI 1.18-1.73 per 10 kg), and body sway (OR = 1.25, 95% CI 1.07-1.45 per 5.15 cm2) were independent risk factors. Preventive measures for bone loss and maintaining a physically active, healthy life-style and modification of risk factors for falls in the elderly could yield beneficial effects in the reduction of the incidence of osteoporotic fracture and hence improve the survival among men.

Independent from muscle power and balance performance, a creatinine clearance below 65 ml/min is a significant and independent risk factor for falls and fall-related fractures in elderly men and women diagnosed with osteoporosis

“…As described previously, we and others observed a significant decline of D-hormone serum levels with a CrCl of <65 ml/min. A CrCl-dependent increase of intact parathormone (iPTH) serum levels was described by different authors [38,58,59] when the CrCl decreases below 40 ml/min. We therefore raise the hypothesis that the risk of fall-associated fractures increases in two steps: first, when it comes to a critical CrCl-associated cut point of decreasing D-hormone serum levels and a second increase in the risk of fall-associated fractures, when it comes to a critical CrCl-associated increase in iPTH serum levels.…”

Diagnosis and treatment of osteoporosis before and after admission to long-term care institutions

“…Indeed, only one of the new bisphophonate medication starts was in men compared to 30 (97%) in women. Others have reported the underdiagnosis and undertreatment of males for osteoporosis despite the recognition that 25% of men will experience an osteoporotic fracture during their lifetime and that 30% of hip fractures and 20% of clinical vertebral fractures occur in males [27][28][29]. Bone loss accelerates in men with increasing age such that bone loss in males at age 85 and older is 2.5 times greater than at age 65 [30].…”

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].…”