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Osteoporosis and consequent fracture are not limited to postmenopausal women. There is increasing attention being paid to osteoporosis in older men. Men suffer osteoporotic fractures about 10 years later in life than women, but life expectancy is increasing faster in men than women. Thus, men are living long enough to fracture, and when they do the...
Contexts in source publication
Context 1
... classification method for osteoporosis 17 devised in 1986 is still helpful in 2014 (Table 1). Osteoporosis has been divided into primary and secondary causes, with primary subdivided by age. ...
Context 2
... has been divided into primary and secondary causes, with primary subdivided by age. The earlier age primary osteoporosis (Table 1) is called postmenopausal osteoporosis because mostly women develop this type of osteoporosis soon after menopause. Trabecular more than cortical bone is affec- ted by Type 1 osteoporosis, as manifested by vertebral and distal radius fractures. ...
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Purpose In the general population, the Fracture Risk Assessment tool (FRAX) is used to assess the 10-year risk of major site and hip fractures; however, it is unclear whether this tool can be applied to patients receiving levothyroxine-based Thyroid Stimulating Hormone (TSH) suppressive therapy for postoperative differentiated thyroid cancer patien...
(1) Background: This study aimed to investigate the relationship of triglyceride glucose–body mass index (TyG-BMI) with bone mineral density (BMD), femoral neck geometry, and risk of fracture in middle-aged and elderly Chinese individuals. (2) Methods: A total of 832 nondiabetic individuals were selected from the prospective population-based HOPE c...
Introduction:
While several risk factors are known to contribute to long-term fracture risk in women with osteoporosis, factors predicting fracture risk over a shorter time horizon, such as over a 1-year period, are less well-established.
Methods:
We utilized a repeated-observations design and data from the Study of Osteoporotic Fractures to ide...
Dual-energy X-ray absorptiometry (DXA) and the Fracture Risk Assessment Tool are recommended tools for osteoporotic fracture risk evaluation, but are underutilized. We present a novel and fully-automated tool to identify fractures, predict bone mineral density (BMD), and evaluate fracture risk using plain pelvis and lumbar spine radiographs. The pe...
Citations
... Men face 2-fold higher mortality rates after fracture than women. [3][4][5] The underrepresentation of men in osteoporosis research has also contributed to suboptimal screening, undertreatment, and underdiagnosis of osteoporosis in men. 6 In postmenopausal women, exercise has been suggested as a safe, non-pharmacologic intervention to maintain bone density and prevent falls. ...
... 12 The positive osteogenic effect of exercise has been noted in younger men, because they attain wider and longer bones at their peak and experience steady trabecular thinning with ageing, rather than loss of trabecular connectivity seen in women at the onset of mid-life. 5,15 Thus, men retain significant trabecular bone, a compartment that is capable of being remodeled with exercise. Despite the reported bonerelated benefits of exercise in healthy young men, it is unclear if exercise will produce similar outcomes in older men with low bone density. ...
Objective
This systematic review aims to determine the effects of exercise on bone and muscle health in men with low bone density.
Data Sources
An electronic search in the following databases was performed: Medline, AMED, Embase, Scopus, and SPORTDiscus between January 1940 and September 2021.
Study Selection
Randomized or non-randomized trials involving any form of exercise in adult men with a densitometric diagnosis of osteoporosis or osteopenia and reported outcomes relating to bone or muscle health. Two independent reviewers screened 12,018 records, resulting in 13 eligible articles.
Data Extraction
One reviewer extracted data into a pre-formed table, including characteristics of the exercise intervention, population examined, and primary and secondary outcomes. Study quality was assessed by 2 independent reviewers using the Tool for assEssment of Study qualiTy and reporting in Exercise (TESTEX).
Data Synthesis
Thirteen publications, originating from 6 unique trials, were eligible for inclusion, which assessed the effect of resistance training, impact training, whole body vibration, and traditional Chinese exercises. Resistance training was the most effective: it stimulates the replacement of adipose tissue with muscle, and in some cases, improved bone density.
Conclusions
Exercise, especially resistance training, slowed down the natural progression of osteoporosis and sarcopenia in men. These benefits are reflected in enhancements to function, such as improved mobility and balance. Other exercise modalities, such as whole body vibration and traditional Chinese exercises, generated minimal improvements to bone health, strength, and balance.
... Nevertheless, some limitations should be noted. First, the RICO study only included women, although osteoporosis also affects men, with approximately one in five men over 50 years of age suffering from this disease worldwide [25]. Men's preferences for fracture risk communications should therefore also be considered. ...
The RICO study indicated that most patients would like to receive information regarding their fracture risk but that only a small majority have actually received it. Patients globally preferred a visual presentation of fracture risk and were interested in an online tool showing the risk.
The aim of the Risk Communication in Osteoporosis (RICO) study was to assess patients’ preferences regarding fracture risk communication.
To assess patients’ preferences for fracture risk communication, structured interviews with women with osteoporosis or who were at risk for fracture were conducted in 11 sites around the world, namely in Argentina, Belgium, Canada at Hamilton and with participants from the Osteoporosis Canada Canadian Osteoporosis Patient Network (COPN), Japan, Mexico, Spain, the Netherlands, the UK, and the USA in California and Washington state. The interviews used to collect data were designed on the basis of a systematic review and a qualitative pilot study involving 26 participants at risk of fracture.
A total of 332 women (mean age 67.5 ± 8.0 years, 48% with a history of fracture) were included in the study. Although the participants considered it important to receive information about their fracture risk (mean importance of 6.2 ± 1.4 on a 7-point Likert scale), only 56% (i.e. 185/332) had already received such information. Globally, participants preferred a visual presentation with a traffic-light type of coloured graph of their FRAX® fracture risk probability, compared to a verbal or written presentation. Almost all participants considered it important to discuss their fracture risk and the consequences of fractures with their healthcare professionals in addition to receiving information in a printed format or access to an online website showing their fracture risk.
There is a significant communication gap between healthcare professionals and patients when discussing osteoporosis fracture risk. The RICO study provides insight into preferred approaches to rectify this communication gap.
... Women typically experience bone loss earlier in life and at a faster rate than men due to hormonal changes at the time of menopause. Osteoporosis in men on the other hand is often overlooked and undertreated [15]. By examining the risks of fractures separately in men and women it is possible to find and highlight potential differences in risk and risk factors between men and women. ...
... This could be an explanation for the higher risk of fractures in RA patients of both sexes. Men are generally examined and treated for osteoporosis to a lesser extent than women [15], and this is also true for men with RA [27]. In the light of the doubled mortality rates after hip fractures in men compared with women [9,15], osteoporosis in men (with and without RA) is in need of more attention. ...
... Men are generally examined and treated for osteoporosis to a lesser extent than women [15], and this is also true for men with RA [27]. In the light of the doubled mortality rates after hip fractures in men compared with women [9,15], osteoporosis in men (with and without RA) is in need of more attention. Falls are important risk factors of fractures and RA patients have been reported to have high risk of falling [4,28,29]. ...
Objectives
To study the risk of osteoporosis-related fractures in a community-based sample of men and women with rheumatoid arthritis (RA) overall, as well as early (< 1 year of disease duration, follow-up time maximum 10 years) and established (RA diagnosis since ≥ 5 years on July 1, 1997) RA, compared with the general population. To study potential risk factors for fractures in patients with RA from baseline questionnaire data.
Methods
A community-based cohort of patients with RA (n = 1928) was studied and compared to matched general population controls. Information on osteoporosis-related fractures (hip, proximal upper arm, distal forearm and vertebral fractures) during the period July 1, 1997 to December 31, 2017 was obtained by linkage to the Swedish National Inpatient Register and the Cause of Death Register. The incidence of fractures was estimated in patients and controls. Cox regression models were used to assess the relation between RA and the risk of fractures and to assess potential predictors of fractures in RA patients. Analyses were stratified by sex, and performed in all patients with RA, and in subsets with early and established RA.
Results
The overall incidence of osteoporosis-related fractures in the RA cohort was 10.6 per 1000 person-years (95% CI 9.31; 12.0). There was an increased risk of fractures overall in both men (hazard ratio (HR) 1.55, 95% CI 1.03; 2.34) and women (HR 1.52; 95% CI 1.27; 1.83) with RA compared to controls, with significantly increased risk also in the hip. No increased risk of osteoporosis-related fractures overall was seen in patients with early RA (HR 1.01, 95% CI 0.69; 1.49). Higher age, longer duration of RA, higher HAQ scores and higher scores in the visual analogue scale for global health were predictors of fractures.
Conclusion
Both men and women with RA were at increased risk of osteoporosis-related fractures. Patients with early RA did not have significantly increased risk during the first 10 years of disease in this study.
... Osteoporosis is a systemic bone disease characterized by osteopenia, increased bone fragility, and an increased risk for fractures. Osteoporosis in men is a growing concern, with clear risk factors including age, alcoholism, hypogonadism, etc. [2]. Hemophilia has not been defined as an obvious cause of secondary osteoporosis. ...
Introduction
People with hemophilia risk osteoporosis more than healthy people, which may be related to specific factors.
Methods
This case-control study included 53 patients with severe hemophilia type A and 49 healthy participants. Dual-energy X-ray absorptiometry (DXA) was used to determine bone mineral density (BMD). Collected information on age, body mass index (BMI), number of joint arthropathies, functional independence score in hemophilia (FISH), bone turnover markers, antibodies, treatment modalities. Identified independent risk factors for osteoporosis.
Results
The BMD of the femoral neck (0.80 g/cm²vs.0.97 g/cm²), ward’s triangle (0.62 g/cm²vs.0.83 g/cm²), tuberosity (0.63 g/cm²vs.0.80 g/cm²) and hip (0.80 g/cm²vs.0.98 g/ cm²) in the case group were significantly lower than those in the control group, all of which were P < 0.001. However, there was no significant difference in the overall BMD of lumbar spine(L1-L4) (1.07 g / cm²vs. 1.11 g / cm²). The frequency of osteoporosis in the case group was 41.51%. BMI and FISH score were considered as independent risk factors for BMD decrease.
Conclusion
The BMD of patients with severe hemophilia A is much lower than that of healthy population, and this difference is mainly reflected in the hip. The clear influencing factors were low BMI and functional independence decrease. Osteoclast was active while osteoblast activity was not enhanced synchronously, which may be the pathological mechanism of BMD decrease.
... Such identification needs a multifactorial analysis that accounts for a series of risk factors, including surrogate measures of bone mechanical properties, neuromuscular control, as well as other epidemiological parameters. (9) Most multifactorial predictive tools in use, such as the fracture risk assessment tools (FRAX) and the Garvan, (10,11) use areal bone mineral density (aBMD) as a surrogate measurement for bone strength. However, aBMD is at best a moderate predictor of proximal femoral strength and future fractures. ...
Bone strength is an important contributor to fracture risk. Areal bone mineral density (aBMD) derived from dual-energy X-ray absorptiometry (DXA) is used as a surrogate for bone strength in fracture risk prediction tools. 3D finite element (FE) models predict bone strength better than aBMD, but their clinical use is limited by the need for 3D computed tomography and lack of automation. We have earlier developed a method to reconstruct the 3D hip anatomy from a 2D DXA image, followed by subject-specific FE-based prediction of proximal femoral strength. In the current study, we aim to evaluate the method's ability to predict incident hip fractures in a population-based cohort (MrOS Sweden). We defined two sub-cohorts: (i) hip fracture cases and controls cohort: 120 men with a hip fracture (<10 years from baseline) and 2 controls to each hip fracture case, matched by age, height, and body mass index; (ii) fallers cohort: 86 men who had fallen the year before their hip DXA scan was acquired, 15 of which sustained a hip fracture during the following 10 years. For each participant, we reconstructed the 3D hip anatomy and predicted proximal femoral strength in 10 sideways fall configurations using FE analysis. The FE-predicted proximal femoral strength was a better predictor of incident hip fractures than aBMD for both hip fracture cases and controls (difference in area under the receiver operating characteristics curve, ΔAUROC = 0.06) and fallers (ΔAUROC = 0.22) cohorts. This is the first time that FE models outperform aBMD in predicting incident hip fractures in a population-based prospectively followed cohort based on 3D FE models obtained from a 2D DXA scan. Our approach has potential to notably improve the accuracy of fracture risk predictions in a clinically feasible manner (only one single DXA image is needed) and without additional costs compared to the current clinical approach.
... The incidence of osteoporotic fractures in both men and women increased with ageing; however, in men the osteoporotic fractures happened about 10 years later than women. 2 The prevalence of osteoporosis in United States (US) men >50 years old was 3-6% whereas in women >50 years old it was 13-18%. 3 The biggest impact of osteoporosis is obviously the incidence of osteoporotic fractures, especially spinal and hip fractures. ...
... Secondary osteoporosis may be present in both men and women, but some studies stated that secondary osteoporosis wasmore common in men than women. 2 Identification of causes of secondary osteoporosis is useful as treatment of the underlying condition will usually improve the treatment of osteoporosis as well. 9 The most common causes of secondary osteoporosis are glucocorticoid excess, hypogonadism and excessive alcohol consumption. ...
Introduction:
Osteoporosis and osteoporotic fracture pose a major public health problem in our ageing population, and particularly concerning is the increased morbidity and mortality associated with osteoporotic hip fractures. While overall diagnosis and treatment for osteoporosis have improved, osteoporosis in men remains underdiagnosed and undertreated. We aim to describe the difference in clinical characteristics between elderly men and women with osteoporotic hip fractures in Sarawak General Hospital.
Materials and methods:
All patients diagnosed with osteoporotic hip fracture admitted to Sarawak General Hospital from June 2019 to March 2021 were recruited, and demographic data and clinical features were obtained.
Results:
There were 140 patients with osteoporotic hip fracture, and 40 were men (28.6%). The mean age for males was 74.1 ± 9.5 years, while the mean age for females was 77.4 ± 9.1 years (p=0.06). The types of fracture consisted of neck of femur=78, intertrochanteric=61 and subtrochanteric=1. More men were active smokers (15% vs 1%, p<0.001). There were 20 men with secondary osteoporosis (50%), while 13 women (13%) had secondary osteoporosis (p<0.001). The causes of secondary osteoporosis among the men were hypogonadism, COPD, glucocorticoid-induced osteoporosis, renal disease, androgen deprivation therapy, thyroid disorder, prostate cancer and previous gastrectomy. There were two deaths among the men and four deaths among the women during the inpatient and 3 months follow-up period. There was no statistical significance between the mortality rates between male patients (5%) and female patients (4%) (p=0.55).
Conclusion:
There were more females with osteoporotic hip fractures, and there were significantly more males with secondary osteoporotic hip fractures.
... Osteoporotic fractures are not limited to postmenopausal women; one in five men (compared to one in two women) over 50 years of age will sustain an osteoporotic fracture in their remaining lifetime [3,4]. A US study reported that men account for 29% of osteoporotic fractures and 25% of the cost of fractures (with the total annual expense for all osteoporosis-related fractures in the USA at approximately $57 billion in 2018, which is comparable to the annual cost of €56 billion estimated in 2019 for Europe) [5][6][7]. ...
Background:
Osteoporosis is often considered to be a disease of women. Over the last few years, owing to the increasing clinical and economic burden, the awareness and imperative for identifying and managing osteoporosis in men have increased substantially. With the approval of agents to treat men with osteoporosis, more economic evaluations have been conducted to assess the potential economic benefits of these interventions. Despite this concern, there is no specific overview of cost-effectiveness analyses for the treatment of osteoporosis in men.
Objectives:
This study aims (1) to systematically review economic evaluations of interventions for osteoporosis in men; (2) to critically appraise the quality of included studies and the source of model input data; and (3) to investigate the comparability of results for studies including both men and women.
Methods:
A literature search mainly using MEDLINE (via Ovid) and Embase databases was undertaken to identify original articles published between 1 January, 2000 and 30 June, 2022. Studies that assessed the cost effectiveness of interventions for osteoporosis in men were included. The Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases and the International Osteoporosis Foundation osteoporosis-specific guideline was used to assess the quality of design, conduct, and reporting of included studies.
Results:
Of 2973 articles identified, 25 studies fulfilled the inclusion criteria, classified into economic evaluations of active drugs (n = 8) or nutritional supplements (n = 4), intervention thresholds (n = 5), screening strategies (n = 6), and post-fracture care programs (n = 2). Most studies were conducted in European countries (n = 15), followed by North America (n = 9). Bisphosphonates (namely alendronate) and nutritional supplements were shown to be generally cost effective compared with no treatment in men over 60 years of age with osteoporosis or prior fractures. Two other studies suggested that denosumab was cost effective in men aged 75 years and older with osteoporosis compared with bisphosphates and teriparatide. Intervention thresholds at which bisphosphonates were found to be cost effective varied among studies with a 10-year probability of a major osteoporotic fracture that ranged from 8.9 to 34.2% for different age categories. A few studies suggested cost effectiveness of screening strategies and post-fracture care programs in men. Similar findings regarding the cost effectiveness of drugs and intervention thresholds in women and men were captured, with slightly greater incremental cost-effectiveness ratios in men. The quality of the studies included had an average score of 18.8 out of 25 (range 13-23.5). Hip fracture incidence and mortality risk were mainly derived from studies in men, while fracture cost, treatment efficacy, and disutility were commonly derived from studies in women or studies combining both sexes.
Conclusions:
Anti-osteoporosis drugs and nutritional supplements are generally cost effective in men with osteoporosis. Screening strategies and post-fracture care programs also showed economic benefits for men. Cost-effectiveness and intervention thresholds were generally similar in studies conducted in both men and women, with slightly greater incremental cost-effectiveness ratios in men.
... The two most prevalent bone risk factors in this cohort were medication-and age-related, with 68% of individuals prescribed oral PrEP having at least one bone risk factor; over 90% of the included cohort were also identified as male. Often considered a concern for women, men also experience negative health effects with BMD loss, which can lead to an increased risk of fractures and osteoporosis [40] . The lifetime risk of osteoporotic fractures (10-25%) has also been rising in men as life expectancy has increased [40] , highlighting the importance of age as a consideration for the choice of oral PrEP regimen. ...
... Often considered a concern for women, men also experience negative health effects with BMD loss, which can lead to an increased risk of fractures and osteoporosis [40] . The lifetime risk of osteoporotic fractures (10-25%) has also been rising in men as life expectancy has increased [40] , highlighting the importance of age as a consideration for the choice of oral PrEP regimen. ...
Objectives
; The only available oral pre-exposure prophylaxis (PrEP) regimens approved in the United States (US) to prevent HIV infection during this study were emtricitabine/tenofovir alafenamide (F/TAF) and emtricitabine/tenofovir disoproxil fumarate (F/TDF). Both agents have similar efficacy, however, F/TAF exhibits improved bone and renal health safety endpoints over F/TDF. The US Preventive Services Task Force (2021) recommends individuals have access to the most medically appropriate PrEP regimen. To understand the impact of these guidelines, the prevalence of risk factors to renal and bone health was evaluated among individuals prescribed oral PrEP.
Methods
; This prevalence study utilized electronic health records of people prescribed oral PrEP from 1-1-2015 through 2-29-2020. Renal and bone risk factors (age, comorbidities, medication, renal function, and body mass index) were identified using ICD and NDC codes.
Results
; Among 40,621 individuals prescribed oral PrEP, 62% had ≥1 renal and 68% had ≥1 bone risk factor. Comorbidities were the most frequent (37%) class of renal risk factors. Concomitant medications were the most prominent (46%) class of bone-related risk factors.
Conclusion
; The high prevalence of risk factors suggests the importance of their consideration when choosing the most appropriate regimen for individuals who may benefit from PrEP.
... An important sex difference was observed in our study: the proportion of males with DXA-confirmed osteoporosis and at high fracture risk and not taking osteoporosis medications was much higher than females across all age groups. Osteoporosis is traditionally underrecognized in males [26], as it is often incorrectly thought to be a woman's disease. Previous work has demonstrated that the factors associated with osteoporosis care utilization in males were comorbidities, adjuvant hormonal therapy for prostate cancer, vertebral or hip fractures, and glucocorticoid treatment [27]. ...
The prevalence of self-reported and DXA-confirmed osteoporosis was 7.8% (males 2.2%; females 12.7%), and 3.6% (males 1.2%; females 5.9%), respectively. We found that most community-dwelling older adults at high fracture risk are not taking osteoporosis medication, particularly males. There is a major opportunity for improved primary fracture prevention in the community.
Purpose
To provide an up-to-date prevalence estimate of osteoporosis, fracture risk factors, fracture risk, and the proportion of older Canadians at high fracture risk who are not taking an osteoporosis medication.
Methods
We included Canadian Longitudinal Study on Aging (CLSA) participants: a community-dwelling cohort aged 45 to 85 years who completed the baseline (2015) comprehensive interview and had dual-energy X-ray absorptiometry (DXA) scans ( N = 30,097). We describe the age- and sex-stratified prevalence of (1) self-reported osteoporosis; (2) DXA-confirmed osteoporosis; (3) fracture risk factors and people who are at high risk (FRAX® major osteoporotic fracture probability ≥ 20%); and (4) people who are at high fracture risk not taking osteoporosis medications. Sampling weights, as defined by the CLSA, were applied.
Results
The mean age of participants was 70.0 (SD 10.3). Overall, 7.8% had self-reported osteoporosis (males 2.2%; females 12.7%) while 3.6% had DXA-confirmed osteoporosis (males 1.2%; females 5.9%), and 2.8% were at high fracture risk (males 0.3%; females 5.1%). Of people who had osteoporosis and were at high risk, 77.3% were not taking an osteoporosis medication (males 92.3%; females 76.8%).
Conclusions
Our study provides an up-to-date prevalence estimate of osteoporosis for community-dwelling older Canadians. We found that most community-dwelling older adults at high fracture risk are not taking an osteoporosis medication, particularly males. There is a major opportunity for improved primary fracture prevention in the community.
... Also, the prevalence of osteoporosis is lower in men than that in women (Lau et al., 2005); however, the rates of sarcopenia are higher in elderly men than that in women in China (Cheng et al., 2014). In addition to old age, the men with fragility fracture, hypogonadism, or prostate cancer with androgen deprivation therapy (ADT) are more susceptible to develop sarcopenia and osteoporosis (Adler, 2014). However, the bone and muscle cells both have androgen receptors, and the ADT causes risk for loss of bone and muscle strength and declined functionality with long-term frailty (Adler, 2014). ...
... In addition to old age, the men with fragility fracture, hypogonadism, or prostate cancer with androgen deprivation therapy (ADT) are more susceptible to develop sarcopenia and osteoporosis (Adler, 2014). However, the bone and muscle cells both have androgen receptors, and the ADT causes risk for loss of bone and muscle strength and declined functionality with long-term frailty (Adler, 2014). ...
Elderly male patients are susceptible to develop osteoporosis and sarcopenia, especially those with fragility fractures, hypogonadism, and prostate cancer with androgen deprivation therapy. However, at present, very few treatments are available for men with sarcopenia. Previous preclinical studies in ovariectomized rats have shown the promising effects of eldecalcitol in ameliorating the bone strength and muscle atrophy. We thus investigated the effects of eldecalcitol on androgen-deficient male mice. Six-week-old male mice underwent orchiectomy (ORX) or sham surgery. Mice were randomly divided into 4 groups (n = 12/per group), including 1) sham mice, 2) ORX group, 3) ORX eldecalcitol 30 ng/kg, and 4) ORX eldecalcitol 50 ng/kg. Eldecalcitol increased bone mass and strength of femur in ORX mice. Eldecalcitol 30 ng/kg dose completely rescued ORX-induced muscle weakness. The RT-qPCR showed that eldecalcitol enhanced the mRNA levels of type I and IIa fibers. The expression levels of MuRF1 and Atrogin-1 of gastrocnemius in the eldecalcitol groups were much lower than that of the ORX group. It is assumed that eldecalcitol potentially acts via PI3K/AKT/FOXOs signaling pathway. These findings provide evidence for evaluating eldecalcitol as an investigational treatment for male patients with sarcopenia and osteoporosis.
