Transcript OSTEOPOROSIS IN MEN

OSTEOPOROSIS IN MEN
Tuan Van Nguyen and Nguyen Dinh Nguyen
Garvan Institute of Medical Research
Sydney, Australia
Vietnam Osteoporosis Workshop, HCM Cty 2006
Background
• Generally unrecognized 20 yrs ago.
• An important public health problem.
• 30% of osteoporotic fractures occur in
men.
Vietnam Osteoporosis Workshop, HCM Cty 2006
Skeleton development
• Peak bone mass closely tied to pubertal
development.
• Male-female differences in the skeleton appear
during adolescence.
• Peak bone mass achieved somewhat later in
boys than girls.
• Trabecular bone: boys=girls
• Cortical bone: boys > girls
• The reasons for sex difference in skeleton
development unclear, but could be related to sex
steroid action.
Vietnam Osteoporosis Workshop, HCM Cty 2006
Prevalence of Osteoporosis
• US, men 50y+: 3% to 6% (vs. 13-18% in
women) (NHANES III, 1984-1994).
• Canada, men 50y+: 2.9% at the lumbar
spine and 4.8% at the femoral neck.
(2001)
• By the year 2020:
– Osteoporosis: 3.3 million Men
– Osteopenia: 17.1 million Men
Vietnam Osteoporosis Workshop, HCM Cty 2006
Causes of Osteoporosis in Men
• Primary:
– Aging
– Idiopathic:
• unknown aetiology, possibly genetic factors
• more common in young men
• Secondary
Vietnam Osteoporosis Workshop, HCM Cty 2006
Secondary Osteoporosis in Men
• Hypogonadism
• Thyrotoxicosis
• Glucocorticoid excess
• Chronic respiratory disorders
• Alcoholism, tobacco abuse
• Anaemias, hemoglobinpathies
• Renal insufficiency
• Immobilization
• Gastrointestinal, hepatic
disorders, malabsorption
• Osteoporosis imperfecta (OI)
• Hyperparathyroidism
• Systemic mastocytosis
• Hypercalciuria
• Neoplastic diseases
• Anticonvulsants
• Rheumatoid arthritis
• Homocystinuria
Vietnam Osteoporosis Workshop, HCM Cty 2006
Osteoporotic fracture in Men
• Lower incidence rates compared to women.
• 30% of osteoporotic fractures occur in men.
• Increased with advancing age.
• Increased with lower BMD.
• BMD-independent factors involved.
• Greater post-fracture mortality compared to
those without fracture.
Vietnam Osteoporosis Workshop, HCM Cty 2006
Incidence of fracture in Men
(Reproduced from Sander et al., 1999)
Vietnam Osteoporosis Workshop, HCM Cty 2006
Incidence of Hip fracture in Men
Vietnam Osteoporosis Workshop, HCM Cty 2006
Incidence of Vertebral fracture in Men
(Adapted from The EPOS Groups, 2002)
Vietnam Osteoporosis Workshop, HCM Cty 2006
Incidence of Wrist fracture in Men
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(Reproduced
from Melton
et al., 1998)
Incidence of other fractures
Vietnam Osteoporosis Workshop, HCM Cty 2006
Risk factors for fracture in Men
Independent risk factors for any fracture in Men
BMD (-0.12g/cm2)
Quadriceps strength (-10kg)
Body sway (+5.5cm2)
0.0
0.5
1.0
1.5
2.0
Hazards ratio (95% CI)
(Source: Nguyen TV et al., Am J Epidemiol, 1996;114:255-63)
Vietnam Osteoporosis Workshop, HCM Cty 2006
Risk factors for Hip fracture
Women
Men
Age (+5 y)
Weight (- 10 kg)
FNBMD (-0.12 g/cm2)
Prior fx
Fall (previous 12 mo)
Body sway (+60cm2)
Quads strength (-10 kg)
0
1
2
3
4
5
6
7 16
17
18
19
20
Hazard rartio
(Source: Nguyen ND et al., JBMR, 2005)
Vietnam Osteoporosis Workshop, HCM Cty 2006
Risk factors for incident Vert-fx
Women
Men,
BMD (-1SD)
Prevalent vertebral fx
1
1.5 2
4
6
8 10
Hazards ratio
(Source: van de Klift M et al., JBMR 2004;19:1172-80)
Vietnam Osteoporosis Workshop, HCM Cty 2006
Evaluation BMD in Men
• Guidelines for the evaluation of
osteoporosis in men not well validated.
• Whether use T-scores based on a malespecific reference range or by using the
same reference range used in women has
been controversial.
•  Currently use a male-specific reference
range is suggested.
Vietnam Osteoporosis Workshop, HCM Cty 2006
Indication for BMD testing
• Men 50y+ who have suffered a fracture
including those with vertebral deformity.
• Younger men who suffer low trauma
fractures.
• Men with secondary causes of bone loss,
including men treated with glucocorticoids
or other medications associated with
osteoporosis.
Vietnam Osteoporosis Workshop, HCM Cty 2006
Laboratory testing
• Serum Ca, P, Creatinine, ALK, WBC.
• Liver function tests.
• Protein electrophoresis in those >50y.
• Serum 25(OH) vitamin D and PTH.
• Serum testosterone and liteinizing hormone.
• 24h urine calcium and creatinine
• Targeted diagnostic testing in men with signs,
symptoms, or other indications of secondary
disorders.
Vietnam Osteoporosis Workshop, HCM Cty 2006
Osteoporosis prevention in Men
• Similar to those in women
• Excellent nutrition and exercise
• Lifestyle
• Calcium and Vitamin D supplementations
• Increasing strength and balance
• Early identifying causes of secondary
osteoporosis
Vietnam Osteoporosis Workshop, HCM Cty 2006
Lời Cảm tạ
• Chúng tôi xin chân thành cám
ơn Công ty Dược phẩm
Bridge Healthcare, Australia là
nhà tài trợ cho hội thảo.
Vietnam Osteoporosis Workshop, HCM Cty 2006
Thank you!
Vietnam Osteoporosis Workshop, HCM Cty 2006