Medline ® Abstracts for References 2-4
of 'Epidemiology and etiology of osteoporosis in men'
Osteoporosis in men.
Orwoll ES, Klein RF
Endocr Rev. 1995;16(1):87.
Bone and Mineral Research Unit, Portland Veterans Administration Medical Center, Oregon, USA.
Severe osteoporosis in men.
Kelepouris N, Harper KD, Gannon F, Kaplan FS, Haddad JG
Ann Intern Med. 1995;123(6):452.
OBJECTIVE: To evaluate men with severe osteoporosis for pathogenetic factors and to review the reported features of primary osteoporosis in men.
DESIGN: Case series and clinical review.
PATIENTS: 47 men consecutively referred to a metabolic bone center because of atraumatic (or minimally traumatic) fractures (91%) or radiographic osteopenia (9%).
MEASUREMENTS: Clinical assessment, radiographs, chemical analyses of serum and urine, hormone assays, skeletal densitometry, and histomorphometry of iliac crest biopsy specimens.
RESULTS: 27 of the 47 men (57%) had vertebral fractures, and 16 (34%) had appendicular fractures. Causal factors identified in 30 men (64%) included glucocorticosteroid treatment (8 men); hypogonadism (7 men); excessive alcohol consumption (7 men); and anticonvulsant use, osteomalacia, severe hyperthyroidism, or bone marrow neoplasia (8 men). Seventeen men (36%) had no medical conditions or known risk factors associated with bone disease. Spinal mineral density was well below the mean value for healthy young men in 94% of the patients with primary osteoporosis tested. Examination of biopsy specimens from 13 of 17 men with primary osteoporosis showed reduced trabecular bone volumes, normal bone formation rates, and slightly increased resorption surfaces. Fasting hypercalciuria was seen in some men (41%). In the primary osteoporosis group, eight men were followed serially (range of follow-up, 6 months to 9 years) while they were receiving a nonpharmacologic regimen (diet and activity); the mean axial bone mineral density of these men increased slightly.
CONCLUSIONS: A thorough evaluation for identifiable causes of severe osteoporosis in men is warranted because definable pathogenetic factors are seen in many cases. A few men with severe osteoporosis have primary or idiopathic osteoporosis. Primary osteoporosis in men is probably caused by many factors because heterogeneous clinical, laboratory, and histologic features were seen in our series and in those of others. Further studies of primary osteoporosis are needed to define the course of the disease, to identify pathogenetic mechanisms, and to develop therapeutic interventions.
Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania School of Medicine, Philadelphia 19104-6149, USA.
Risk factors for spinal osteoporosis in men.
Seeman E, Melton LJ 3rd, O'Fallon WM, Riggs BL
Am J Med. 1983;75(6):977.
Risk factors for vertebral fractures due to osteoporosis were evaluated in 105 consecutive male patients over a four-year period. An equal number of men with Paget's disease, matched by age, who concurrently attended the same subspecialty clinic served as control subjects. The relative risk for osteoporosis, estimated by the odds ratio, was increased among those who smoke cigarettes (relative risk = 2.3; p = 0.01), drank alcoholic beverages (relative risk = 2.4; p = 0.02), or had an associated medical disease known to affect calcium or bone metabolism (relative risk = 5.5; p less than 0.001). Obesity was protective (relative risk = 0.3; p less than 0.001). As assessed by a multiple logistic model, the risk associated with smoking and drinking increased with age. The effects of these four major risk factors were largely independent of one another and were cumulative. Thus, spinal osteoporosis in men is frequently associated with recognizable risk factors, some of which are potentially remediable.