[Osteoporosis in men under 65 years old presenting as vertebral crushing: idiopathic or secondary? Study of 9 cases]

Osteoporosis in young or middle age men is unusual and requires an extensive diagnostic work-up.

To report a retrospective review of nine men with osteoporosis.

The charts of nine men aged 27 to 61 years old (mean 39), that presented with a primary diagnosis of osteoporosis, were reviewed.

Subjects were subjected to a diagnostic work up five years after the onset of symptoms. Their body mass index ranged from 21.7 to 26.3 kg/m2, all had vertebral fractures (crush fractures in 8 and a biconcave deformity in one) between T4 and L4 and all had normal serum calcium, phosphate, alkaline phosphatase and creatinine. Four patients had a history of nephrolithiasis and three had hypercalciuria. Bone density, measured in seven patients with a dual photon densitometer, showed a mean Z score of -2.0 in the spine and of -2.2 in the femoral neck. The final diagnoses of these patients were Cushing's disease in two, malabsorption syndrome in one, use of phenobarbital and hydantoin in one, overt renal hypercalciuria with low calcium intake in one and alcoholic liver disease in one. In three patients, osteoporosis was considered idiopathic. Of these, two had moderate absorptive hypercalciuria as a presumable risk factor.

Six of the nine studied male patients with osteoporosis had an underlying cause and in three, this condition was considered idiopathic.