Determinants of Bone Mineral Density in Older Men

Abstract

Although osteoporosis in men is increasingly recognized as an important health issue and bone mass appears to be a major determinant of fracture, there remain few data concerning the determinants of bone mass in men. To determine the correlates of bone density in men, we studied a large group of older subjects recruited from three rural communities in the northwestern United States. Three hundred and fifty-five men over the age of 60 years (mean 71.5 +/- 7.4 years) without known disorders of mineral metabolism were recruited by community advertising. Bone mineral density was measured at the lumbar spine, proximal femur and radius by dual-energy X-ray absorptiometry, and factors potentially related to skeletal status were assessed by direct measurements or questionnaire. In univariate analyses weight (positively) and age (negatively) were associated with bone density. After adjustment for these two factors, alcohol intake, osteoarthritis and thiazide use were associated with higher bone density, while previous fractures, gastrectomy, peptic ulcer disease, rheumatoid arthritis, glucocorticoid use, hypertension, previous hyperthyroidism, height loss since age 20 years, chronic lung disease and smoking were related to lower density. In multivariate models, only weight and a history of cancer were related to higher bone mass, and age, previous fracture, rheumatoid arthritis, gastrectomy and hypertension were associated with lower density. These data contribute to the emerging field of osteoporosis in men, and may help in the clinical identification of men at higher risk of osteopenia.

Risk factors for hip fractures in a middle-aged population: a study of 33,000 men and women

“…Previous studies have shown lower BMD in patients with trochanteric hip fractures compared with cervical hip fracture patients [19,20]. Since some significant risk factors for trochanteric hip fracture identified in this study are also risk factors for having low BMD, one could speculate that individuals suffering from trochanteric hip fracture may also have low BMD already in middle age [39][40][41][42]. Unfortunately, baseline assessment in this population was done before access to DXA (dual x-ray absorptiometry) and we are therefore unable to evaluate our speculations.…”

Risk factors for low BMD in healthy men age 50 years or older: a systematic review

“…In these studies, current smokers had greater risk than former smokers at the hip. At the lumbar spine, the risk was similar for current and former smokers [18,28,[30][31][32].…”

“…At the hip, there was consistent evidence that BMD declines with age [20][21][22][23][24][25][26][27][28]. In men age 50 to 80 years or older (age range varied by study), in multivariable analyses hip BMD decreased linearly with age at a rate of approximately 1.5-2.5% per decade [20,26] and decreased by up to 5% per decade in univariate analyses [20,25,28]. In longitudinal studies, the crude rate of bone loss (expressed as a percentage of baseline BMD/year) at the hip was approximately 0.3-0.5% per year [21][22][23][24].…”

“…In four studies [18,28,30,31], both current and former smokers were at greater risk for low BMD compared with nonsmokers, except in one study [20] where the risk was not significant and was attenuated particularly by adjusting for weight. In these studies, current smokers had greater risk than former smokers at the hip.…”

Determining Risk of Vertebral Osteoporosis in Men: Validation of the Male Osteoporosis Risk Estimation Score

“…36 In addition, the prevalence potentially may be affected by concurrent osteoarthrosis. Osteoarthrosis involves hypertrophy of the bone and increases apparent BMD without necessarily increasing strength, an observation also reported by Cauley et al 27 in the MrOS Research Group report and by Orwoll et al 37 The competing effects of the expected decline in BMD associated with aging and the expected increase in BMD associated with osteoarthrosis over time may lead to misclassification of men with lumbar osteoporosis as "normal," which may render densitometry less reliable for the diagnosis of lumbar osteoporosis. In effect, this misclassification decreases the observed prevalence of osteoporosis and necessarily increases the NNS to prevent one additional vertebral fracture at any given age.…”