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Osteoporosis in Men

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Endocrinology and Diabetes

Abstract

Osteoporosis is characterized by bone loss with microarchitectural deterioration, reduced bone strength, and increased risk of fracture (Kanis et al., J Bone Miner Res 9:1137–41, 1994; NIH Consensus Development Panel on Osteoporosis Prevention, South Med J 94:569–73, 2001). It is, in part, a disorder of the aging skeleton and, thus, as the world population ages, it is inevitable that the incidence of this disease will also increase. For example, in the USA during the first quarter of this century, the population greater than 50 years old will increase by 60 % (Day, Population projections of the USA by age, sex, race, and hispanic origin: 1995 to 2050. US Bureau of the Census, Current Population Reports, US Government Printing Office, Washington, DC, P25-1130, 1996; Cummings and Melton, Lancet 359:1761–7, 2002). With that increase in the older population will come a greater incidence of osteoporosis. This disease has traditionally been considered to be a disease of postmenopausal women but men now constitute nearly 1/4 of all osteoporotic patients (Burge et al., J Bone Miner Res 22(3):465–75, 2007; Center et al., JAMA 297:387–94, 2007). Hip fracture, which accounts for at least 1/3 of all fractures in men (Gullberg et al., Osteoporos Int 7:407–13, 1997), is associated with a threefold higher mortality rate in men than in women (Center et al., Lancet 353:878–82, 1999). Data from Trombetti et al. (Osteoporos Int. 13:731–7, 2002) show that more years of life are lost in men than in women after a hip fracture. This may be due, at least in part, to the impression that men are typically older when they sustain a hip fracture and are, therefore, more likely to suffer from serious comorbid events when they fracture. Data from the classic study of Johnell and Kanis (Osteoporos Int 17:1726–33, 2006), however, indicates that worldwide, the peak number of hip fractures occurs at a similar age for men and women, between the ages of 75 and 79.

Moreover, similar to women, the absolute risk of a subsequent fracture in men increases substantially after the first fragility fracture (Center et al., JAMA 297:387–94, 2007). The Australian Dubbo Osteoporosis Study noted that the relative risk of a second fracture after an initial osteoporotic fracture in a cohort of community-dwelling men > 60 years old was 3.47 (CI 95 %: 2.69–4.48) while for women, the relative risk of the second fragility fracture was 1.97 (CI 95 %: 1.71–2.26). Mortality risk was also greater when the second fracture occurred, again with men showing greater mortality [11.3 per 100 person-years (95 % CI, 9.8–13.0)] than women [7.8 per 100 person-years (95 % CI, 7.1–8.5)] (Bliuc et al., JAMA 301:513–21, 2009). The cohort in the ongoing, large epidemiologic study of male skeletal health known as MrOs (The Osteoporotic Fractures in Men Study) included a large international sample of men > 65 years old. In MrOs, the advent of a rib fracture resulted in a twofold increased risk of future rib, hip, or wrist fracture, independent of BMD or other factors (Barrett-Connor et al., BMJ 340: c1069, 2010).

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Disclosures

Dr. Bilezikian is a consultant for Eli Lilly, NPS Pharmaceuticals, Merck, GSK, Novartis, and Amgen, and receives research support from NPS Pharmaceuticals and Amgen. Drs. Costa, Cusano, and Silva: No conflicts of interest reported.

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Authors and Affiliations

  1. Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians & Surgeons, Columbia University, 630 West 168th Street, PH 8W-864, New York, NY, 10032, USA

    Aline G. Costa M.D., Natalie E. Cusano M.D., Barbara C. Silva M.D., Ph.D. & John P. Bilezikian M.D.

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  1. Aline G. Costa M.D.
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  2. Natalie E. Cusano M.D.
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  3. Barbara C. Silva M.D., Ph.D.
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  1. Professor Associado e Livre-Docente, Disciplina de Endocrinologia da Faculdade de Ciências Medicas da Universidade de Pernambuco, Chefe da Divisão de Endocrinologia e Diabetes do Hospital Agamenon, Magalhães-MS/UPE, Recife, Brazil

    Francisco Bandeira

  2. American Thyroid Association Past President, American Association of Clinical Endocrinologists, Professor of Medicine, Mayo Clinic College of Medicine President-Elect, Rochester, Minnesota, USA

    Hossein Gharib

  3. Federal Foundation and School of Medical Sciences, Porto Alegre, Brazil

    Airton Golbert

  4. Department of Medicine, University of Pernambuco School of Medicine, Recife, Brazil

    Luiz Griz

  5. Department of Medicine, University of Maranhao School of Medicine, Sao Luis, Brazil

    Manuel Faria

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Costa, A.G., Cusano, N.E., Silva, B.C., Bilezikian, J.P. (2014). Osteoporosis in Men. In: Bandeira, F., Gharib, H., Golbert, A., Griz, L., Faria, M. (eds) Endocrinology and Diabetes. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8684-8_25

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