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The dilemma of osteoporosis in men
1Austin Hospital, University of Melbourne, Australia.
Insights
Men experience higher hip fracture mortality and increasing incidence, posing a growing public health challenge. Bone fragility in men is influenced by factors like bone size, density, and loss patterns, with hormonal changes potentially contributing.
Area of Science:
- Gerontology
- Orthopedics
- Endocrinology
Background:
- Hip fractures in men represent one-third of all hip fractures, carrying a higher mortality rate compared to women.
- The increasing age-specific incidence of hip fractures in men signifies a growing public health burden.
- Vertebral fractures, while less impactful in terms of mortality and cost, are debilitating and common in clinical practice.
Purpose of the Study:
- To analyze the unique patterns of bone loss and fragility in aging men.
- To compare bone characteristics in men with hip fractures versus vertebral fractures.
- To investigate the potential role of hormonal decline in age-related bone loss and fracture risk in men.
Main Methods:
- Review of existing literature on bone aging, fracture incidence, and risk factors in men.
- Comparison of bone structural properties (size, density, trabecular and cortical bone loss) between men and women.
- Analysis of potential hormonal influences (testosterone, growth hormone, IGF-1) on bone metabolism in aging men.
Main Results:
- Men have larger bone size and greater peak bone mass, but similar peak bone density compared to women.
- Cortical bone loss is less pronounced in men due to reduced endocortical resorption and greater periosteal formation.
- Trabecular bone loss patterns differ: thinning predominates in hip fractures, while loss of connectivity is seen in vertebral fractures.
Conclusions:
- Men's bone fragility is influenced by larger bone size, differential bone loss patterns, and compensatory periosteal growth.
- Reduced bone density in men with fractures may stem from lower peak bone density and accelerated bone loss.
- Age-related hormonal decline and associated illnesses may contribute to reduced bone formation and increased resorption in aging men.
Abstract:
Hip fractures in men account for one third of all hip fractures and have a higher mortality than in women. The age-specific incidence of hip fractures is increasing so that the public health burden will increase out of proportion to the burden imposed by the increase in the numbers of elderly men in the community. Vertebral fractures are a public health problem of lesser magnitude in terms of morbidity, mortality, and cost, but they are debilitating and are seen commonly in clinical practice. (Forearm fractures should probably not be regarded as a public health problem.) The pattern of earlier gain/later loss of bone during ageing in healthy men is well documented. Peak bone mass is higher in men than women because men have bigger bones. Peak bone density is the same. The absolute amount of trabecular bone lost at the spine and iliac crest during ageing is similar in men and women. Cortical bone loss is less in men. It is less because endocortical resorption is less, and periosteal formation is greater, in men. Bone loss may accelerate in elderly men and women (rather than decelerate), perhaps because endocortical resorption and increasing cortical porosity increase the effective surface available for resorption in cortical bone. Thus, bone fragility is less in men because (a) the cross-sectional surface of the vertebral body is larger; (b) trabecular bone loss is less as a percentage of the higher peak bone mass; (c) trabecular bone loss occurs by thinning rather than perforation; and (d) periosteal appositional growth compensates for endocortical resorption by maintaining the bending strength of bone. Reduced bone density in men with fractures may be due to reduced peak bone density and bone loss. As found in women with spine fractures, men with fractures have smaller bone size. Bone loss occurs by reduced bone formation and increased bone resorption. Loss of connectivity appears to predominate in men with vertebral fractures; trabecular thinning appears to predominate in men with hip fractures. Whether men with fractures have increased bone fragility due to reduced periosteal appositional growth during ageing is unknown. The age-related decline in testosterone, adrenal androgens, growth hormone, and insulin-like growth factor 1 may be concomitants of ageing or may contribute to reduced bone-formation and bone loss. Men with vertebral fractures may be more deficient in growth hormone and insulin-like growth factor 1. Thy often have illness, hypogonadism, or illnesses associated with hypogonadism that should be sought with a high index of suspicion.(ABSTRACT TRUNCATED AT 400 WORDS)