Vietnam Osteoporosis Workshop, HCM Cty 2006 OSTEOPOROSIS IN MEN Tuan Van Nguyen and Nguyen Dinh...

Vietnam Osteoporosis Workshop, HCM Cty 2006

OSTEOPOROSIS IN MEN

Tuan Van Nguyen and Nguyen Dinh Nguyen

Garvan Institute of Medical Research

Sydney, Australia


Background

• Generally unrecognized 20 yrs ago.

• An important public health problem.

• 30% of osteoporotic fractures occur in men.


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.


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


Causes of Osteoporosis in Men

• Primary:

– Aging

– Idiopathic:

• unknown aetiology, possibly genetic factors

• more common in young men

• Secondary


Secondary Osteoporosis in Men• Hypogonadism

• Glucocorticoid excess

• Alcoholism, tobacco abuse

• Renal insufficiency

• Gastrointestinal, hepatic disorders, malabsorption

• Hyperparathyroidism

• Hypercalciuria

• Anticonvulsants

• Thyrotoxicosis

• Chronic respiratory disorders

• Anaemias, hemoglobinpathies

• Immobilization

• Osteoporosis imperfecta (OI)

• Homocystinuria

• Systemic mastocytosis

• Neoplastic diseases

• Rheumatoid arthritis


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.


Incidence of fracture in Men

(Reproduced from Sander et al., 1999)


Incidence of Hip fracture in Men


Incidence of Vertebral fracture in Men

(Adapted from The EPOS Groups, 2002)


Incidence of Wrist fracture in Men

(Reproduced from Melton et al., 1998)


Incidence of other fractures


Risk factors for fracture in Men

Hazards ratio (95% CI)

0.0 0.5 1.0 1.5 2.0

BMD (-0.12g/cm2)

Quadriceps strength (-10kg)

Body sway (+5.5cm2)

Independent risk factors for any fracture in Men

(Source: Nguyen TV et al., Am J Epidemiol, 1996;114:255-63)


Risk factors for Hip fracture

Hazard rartio

0 1 2 3 4 5 6 7 16 17 18 19 20

WomenMen

Age (+5 y)

Weight (- 10 kg)

Fall (previous 12 mo)

Prior fx

FNBMD (-0.12 g/cm2)

Body sway (+60cm2)

Quads strength (-10 kg)

(Source: Nguyen ND et al., JBMR, 2005)


Risk factors for incident Vert-fx

Hazards ratio

1 1.5 2 4 6 8 10

Men, Women

BMD (-1SD)

Prevalent vertebral fx

(Source: van de Klift M et al., JBMR 2004;19:1172-80)


Evaluation BMD in Men

• Guidelines for the evaluation of osteoporosis in men not well validated.

• Whether use T-scores based on a male-specific reference range or by using the same reference range used in women has been controversial.

Currently use a male-specific reference range is suggested.


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.


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.


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


Lời Cảm tạ

• Chúng tôi xin chân thành cám ơn Công ty Dược phẩm Bridge Healthcare, Australia là nhà tài trợ cho hội thảo.


Thank you!

Vietnam Osteoporosis Workshop, HCM Cty 2006 OSTEOPOROSIS IN MEN Tuan Van Nguyen and Nguyen Dinh...

Documents

Transcript of Vietnam Osteoporosis Workshop, HCM Cty 2006 OSTEOPOROSIS IN MEN Tuan Van Nguyen and Nguyen Dinh...