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MEN’S
HEALTH

Osteoporosis in Men:
Less frequent, but more lethal
By Aruna Venkatesh, MD

In the United States, about 1.5 million men over age 65 years have osteoporosis and another 3.5
million men are at risk. Lifetime risk of osteoporotic fracture is about 25 percent for a 60 year old
man. By age 90, one of every six men will have a hip fracture. While the prevalence of osteoporotic
fractures is lower – a third to a fifth of that seen in women – mortality rates are higher in men.

Osteoporosis is characterized by low bone mass and fragility of the skeleton, resulting in an increased
risk of fracture especially at the spine, hip and wrist.

Diagnosis: • Malnutrition
DXA measurements of the spine and hip are recommended. • Muscle deficits
• Decreased physical activity
DXA stands for dual-energy X-ray absorptiometry which is a • Chronic inflammation
means of measuring bone mineral density or BMD. Diagnosis is • Chronic glucocorticoid use
based on the lowest T–score measured. Hip BMD (bone mineral Age related bone–loss is the single largest risk factor for fragility
density) has the highest predictive value for hip fracture, while fractures but the risk begins about 10 years later than women
spine BMD has less variability and can detect responses to ther- Secondary causes can be identified in 40–60 percent of men with
apy earlier than hip BMD. World Health Organization diagnos- osteoporotic fractures
tic thresholds based on BMD at the hip for men over the age 50 • Hypogonadism
are DXA T–score ≤ – 2.5 for osteoporosis and T–score between • Chronic glucocorticoid therapy
–1 and –2.5 for osteopenia. For those younger than 50, clinical • Malabsorption
history of fragility fracture and/or other risk factors for osteo- • Vitamin D deficiency
porosis are used for diagnosis. • Anti–convulsant therapy
• Hypercalciuria
Pathogenesis: • Alcohol abuse and smoking
Decreased bone mass results when
• Peak bone mass achieved is low Who should be tested?
• Bone resorption exceeds bone formation during remodeling • Routine testing of BMD in men is generally not recommended
• All these processes may contribute (some specialty organizations recommend testing in men over age
Peak Bone mass depends on 70)
• Normal pubertal sex steroids secretion • DXA BMD for
• Timing of puberty – constitutional delay in puberty results in • Clinical manifestations of low bone mass
significant reduction in bone density • radiographic osteopenia
Ethnicity • history of low trauma fractures
African Americans have higher BMD followed by Whites. Asian • loss of more than 1.5 inches in height,
and Hispanic Americans have lower BMD but may have lower • Risk factors for fracture
hip fracture rates especially among Hispanics. • long–term glucocorticoid therapy
• androgen deprivation therapy for prostate cancer
Environmental factors • hypogonadism
Physical activity during childhood enhances and maintains bone • primary hyperparathyroidism
• intestinal malabsorption disorders
mass and density. Chronic diseases during childhood adversely in-
fluence attainment of peak bone mass.

22 San Antonio Medicine • December 2015