Bone mineral density and vertebral fractures in men

Area of Science:

• Orthopedics
• Radiology
• Gerontology

Background:

• Vertebral fragility fractures increase with declining bone mineral density (BMD) in women.
• Limited data exists on BMD and vertebral fractures in men, with uncertainty regarding the magnitude of this relationship compared to postmenopausal women.

Purpose of the Study:

• To examine the relationships between spine and hip BMD and vertebral fractures in middle-aged men with lumbar osteopenia.
• To determine the predictive value of BMD at different sites for vertebral fractures in this population.

Main Methods:

• 200 men (mean age 54.7) with lumbar osteopenia (T-score < -1.5) were recruited.
• Dual-energy X-ray densitometry assessed lumbar (L2-L4) and hip BMD (femoral neck, trochanter, intertrochanter, Ward's triangle, total hip).
• Spinal radiographs analyzed for vertebral crush fractures (≥20% height reduction).

Main Results:

• 59.5% of patients had at least one vertebral crush fracture.
• Age, femoral BMD, and spine BMD were significant predictors of vertebral fractures.
• Odds ratios for fracture risk decreased by 1 SD: 1.8 (spine BMD) to 2.3 (total hip BMD).
• Hip BMD showed higher odds ratios than spine BMD, especially in men under 50.
• A total femoral T-score < -2.5 increased vertebral fracture risk 2.7-fold, versus 2-fold for spine T-score < -2.5.

Conclusions:

• Confirms strong association of age and BMD with vertebral fractures in middle-aged men.
• Femoral area BMD measurement is the best predictor of vertebral fracture risk.
• Low femoral BMD may indicate severity in younger men with lumbar osteopenia.