Aetiology and Presenting Symptoms in Male Osteoporosis

Abstract

In order to analyse the clinical characteristics and the principal causes of osteoporosis in men, 81 osteoporotic males from an out-patient rheumatology department were studied. Bone mass assessment, automated biochemical profile and biochemical markers of bone turnover were performed in all patients, and hormonal measurements were taken when a specific aetiology was not readily apparent. Sixty-three men (78%) had secondary osteoporosis and 18 (22%) primary osteoporosis. Secondary causes of osteoporosis included hypogonadism (12 patients), corticosteroid therapy (10 patients) and alcoholism (10 patients); the remaining patients had various causes of osteoporosis. Eighteen patients had primary osteoporosis, eight of them with associated hypercalciuria. Normocalciuric patients showed lower 25-hydroxyvitamin D and 1-25-hydroxyvitamin D levels than the control group, whereas hypercalciuric patients had lower parathyroid hormone and renal threshold for phosphate excretion. In 69 patients (85%), back pain was the chief complaint. Forty-five of these 69 patients (65%) had chronic back pain and 24 (35%) had subacute episodes. Fifty per cent of the patients with chronic back pain had vertebral fractures. Both patients with and without chronic back pain were found to have a similar number of vertebral fractures. In conclusion, male osteoporosis is frequently associated with major risk factors. Patients with primary osteoporosis may have associated hypercalciuria or decreased vitamin D levels. However, not all the patients for whom back pain was the chief complaint were found to have vertebral fractures.

Is Distal Forearm Fracture in Men due to Osteoporosis?

“…This is similar to the 55% found previously in men with symptomatic vertebral fractures in the United Kingdom [14,15] and in other centers around the world [16,17]. This adds further to the evidence that secondary causes of osteoporosis are common in men with osteoporotic fractures.…”

Guidelines on the management of osteoporosis associated with chronic liver disease

“…Thirty per cent had vertebral compression fractures although only 4% were symptomatic. 34 In a further study of 58 male non-cirrhotic drinkers, osteopenia was seen in 23% drinking >10 units/day and cumulative Osteoporosis is defined as T score <−2.5 except for: *defined as fracture threshold below 0.85 g/cm 2 ; **defined as z score <−2. ALD, alcoholic liver disease; PBC, primary biliary cirrhosis; PSC, primary sclerosing cholangitis; BMD-LS, bone mineral density in lumbar spine.…”

“…In men, excess alcohol, irrespective of cirrhosis or low testosterone levels, is a risk for osteoporotic fractures. [29][30][31][32][33][34][35][36] In a study of 76 men drinking more than 27 units/day for more than 24 years, only 22% of whom had abnormal hepatic histology, lumbar spine BMD was lower than in age matched controls. Thirty per cent had vertebral compression fractures although only 4% were symptomatic.…”

A Randomized Trial of Nasal Spray Salmon Calcitonin in Men With Idiopathic Osteoporosis: Effects on Bone Mineral Density and Bone Markers

“…(1) Unlike women, men frequently have an underlying secondary cause of osteoporosis and we and others have found such a cause in Ͼ50% of men with osteoporosis. (2)(3)(4) There is a subgroup of patients (40 -50% of men in most series) without associated risk factors who are believed to have primary osteoporosis, also called "idiopathic osteoporosis. "…”