Osteoporosis and osteoporosis-relat...

Osteoporosis and osteoporosis-related fractures are usually considered conditions of postmenopausal or somewhat advanced in life women, but these problems also fall out in men. (1-3) In fact, nearly 30 percent of hip fractures be found in men. (4) Because osteoporosis is clinically silent until fractures fall out men at risk for osteoporosis and those who have the disease ne to be identified. one time identified, they can be readily treated, thus possibly decreasing the morbidity and mortality that are associated with osteoporotic fractures.

Pathogenesis

Osteoporosis is defined as a decrease in bone mass greater than wait fored for a person's sex, age, and race. Age-related osteoporosis causes los in the pair trabecular and cortical bone. The personality of osteoporosis indicates an increased risk of fracture of the spine, proximal thigh-bone or distal radius.

Men and women reach peak bone density on their early 20s. (5) Peak bone density is heavily influenced from heredity, nutrition, hormonal effects, and environment. Thus, suboptimal bone bourgeoning related to poor nutrition or subdued calcium intake during childhood and adolescence is as important as bone los related to the increase of osteoporosis. (6)

Because men's bone are bigger and longer than women's, they have greater total bone mass (Table 1) (357) Men and women however, have the same trabecular number and thickness, in the way that when values are adjusted for bone bulk men and women have similar peak bone mineral density (BMD) (78)

In the two men and women, age-related bone los begins at about age 50 (5) Acute hypogonadism at any age, of the like kind as that resulting from orchiectomy for prostate cancer, accelerates bone los to a rate similar to that of menopausal women The bone los following orchiectomy is rapid for several years, then turn backs to the gradual loss that normally offers with aging.

Epidemiology and Clinical concatenations of Aging

About 4 to 6 percent of men older than 50 have osteoporosis, and 33 to 47 percent have osteopenia (diminished bone los not meeting diagnostic criteria for osteoporosis). (1) The prevalence of osteoporosis is 7 percent in white men 5 percent in black men and about 3 percent in Hispanic-American men (9) Data in succession the prevalence of osteoporosis in Asian-American men and other ethnic disposes are lacking.

Because men have greater bone mass, they not away with osteoporotic fracture about 10 years later than women (Figure 1) (10) Thus, starting at about age 75 the incidence of hip fracture increases rapidly. Because of the predicted sprouting in the number of somewhat advanced in life persons in this country, the number of men with hip fracture also is anticipateed to increase dramatically. (4)

one time hip fractures occur, men have higher rates of morbidity and mortality than women For example, men are twice as likely as women to die in a hospital after a hip fracture. (7) Similarly, hip fracture mortality in men single in kind year after fracture is 31 percent compared with a rate of barely 17 percent in women. (11) This increased mortality is likely to be caused from older age at the time of fracture and the demeanor of comorbid conditions. (12)

In male survivors of hip fracture, more than the same half have chronic pain at six month and require assistance with walking. (13) individual third of these men act upon to a nursing home or a relative's domicile (14) Morbidity includes a los of self-sufficiency related to decreased independence after fracture and changed appearance related to kyphosis.

Risk Factors for Osteoporosis

Although the unravelling of osteoporosis in men is primarily related to aging and genetic factors, 30 to 60 percent of cases of osteoporosis are associated with the same or more secondary risk factors (615) (Table 2) (36716)

GLUCOCORTICOID THERAPY

Long-term oral glucocorticoid therapy accounts for nearly the same in six cases of male osteoporosis. (17) The compass of bone loss is related to the duration of therapy and the dosage of the steroid. Because of the high risk of bone los treatment of osteoporosis is praiseed for any patient taking 5 mg or more of steroids by day for longer than six month (18) The approveed treatment is a bisphosphonate supplyed with calcium and vitamin D (7)

ANTICONVULSANT THERAPY

Anticonvulsant medication use, specifically phenytoin (Dilantin) and phenobarbital, may contribute to osteoporosis between the walls of multiple effects on calcium metabolism. (19) Specifically, anticonvulsant medicines increase hepatic metabolism of vitamin D and 25-hydroxyvitamin D resulting in decreased intestinal calcium absorption. Men taking phenytoin or phenobarbital also should take supplemental calcium and vitamin D and be considered for bisphosphonate or teriparatide therapy if their bone density is low

soft LEVELS OF ANDROGENS

Androgens are required for developing peak bone mass and maintaining bone mass. Hypogonadal young men with cheap testosterone levels have low bone density; testosterone replacement therapy increases bone density in this arrange (20) Testosterone levels gradually decline with advancing age, if it were not that low levels in elderly men have not been erect to correlate with low bone density. (21) Furthermore, administering testosterone to somewhat old men may cause undesirable side weights related to increased prostate size and may on a level promote the development of hidden prostate cancer.