OSTEOPOROSIS IN MEN Tuan Van Nguyen and Nguyen

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 50 y+: 3% to 6% (vs. 13 -18% in women) (NHANES III, 1984 -1994). • Canada, men 50 y+: 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 Vietnam Osteoporosis Workshop, HCM Cty 2006 (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 (Source: Nguyen TV et al. , Am J Epidemiol, 1996; 114: 255 -63) Vietnam Osteoporosis Workshop, HCM Cty 2006

Risk factors for Hip fracture (Source: Nguyen ND et al. , JBMR, 2005) Vietnam Osteoporosis Workshop, HCM Cty 2006

Risk factors for incident Vert-fx (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 50 y+ 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 >50 y. • Serum 25(OH) vitamin D and PTH. • Serum testosterone and liteinizing hormone. • 24 h 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