Male Osteoporosis: More Common Than We Think
Male osteoporosis is more common than most believe, probably due to the fact that it is under-diagnosed by physicians who have not traditionally considered it a part of the "Male Health Profile." The disease, which causes bones to become brittle thus making them susceptible to breaking, appears in men as it does in women: with a fracture. As is the case for women, earliest diagnosis is through a bone density test. However, until the prevalence of male osteoporosis is better known, male bone density screening for men 50 years of age is not currently recommended.
Secondary Risk Factors
Alcohol (and smoking to a lesser degree) tends, in higher doses, to damage the liver, which can effect Vitamin D metabolism, as well as suppress the production of male hormone in the testes. Alcohol probably damages bone through a direct negative effect on the bone forming cells. Nutrition is a secondary factor. Those who are malnourished have very low bone density.
Presentation at the 55th Annual Meeting of the AACC
Clifford J. Rosen, M.D. is the Director of the Maine Center for Osteoporosis Research and Education and is affiliated with St. Joseph Hospital, both in Bangor, ME. He will present an update on the status of his laboratory's work during a talk entitled, "Male Osteoporosis," is delivering at the 55th Annual Meeting of the American Association of Clinical Chemistry (AACC) being held July 20-24, 2003, at the Pennsylvania Convention Center, Philadelphia, PA. More than 16,000 attendees are expected.
The Centers study involving mice show that there are gender-specific genetic factors at play; therefore, even without the presence of secondary factors such as alcohol, smoking and male hormone, males tend to have some higher risk when it is associated with some genetic predispositions.
It is not practical to screen every male at the present time using a bone density screen. The development of a genetic screening tool would make it easier to identify those at risk. From a primary care physician standpoint, Rosen says he believes that men who are over 50 and complaining of unexplained back pain or other secondary causes such as history of kidney stones, alcoholism, and steroids usage, should be screened with bone density testing.
For those men they are trying to identify who have no identifiable risk factors there are no current markers to use. They have been working with one protein – IGF profactor-1 as a potential risk factor in men with osteoporosis. The relationship is not direct between IGF and low bone mass
What Is the Cause?
The cause of male osteoporosis is not yet understood, but Rosen observes that men with the following history are at greatest risk:
- Genetics : If a man's mother or father had osteoporosis, that individual is significantly more likely to have it than a male whose parents had no such history.
- Kidneys stones: men with kidney stones, a somewhat common disorder among males, are at high risk.
- Pituitary problems or problems with male hormone production: men who have experienced either problem are at very high risk.
- Treatment with glucocorticoids: Men who have been treated with glucocorticoids (cortisone or prednisone) for other conditions such as asthma, chronic obstructive pulmonary disease (COPD), Crohn's Disease, rheumatoid arthritis, any of the post-transplant conditions are at risk.
Recommendations
Rosen recommends that men over 55 who have inexplicably lost two or more inches in height be tested immediately for bone density. So, too, should any man who has sustained a fracture in his adult life since the presence of a fracture is a very potent risk factor. After such a diagnosis is made, the first step in treatment is to remove any contributory factors, such as kidney stones, underlying factors such as alcohol, or improve other factors, such as diet and calcium intake should be improved. Then aggressively treat osteoporosis, such as Vitamin D along with using first line therapies to treat the disease such as Fosomax®. Vitamin D should also be used to treat the condition.
The American Association for Clinical Chemistry (AACC) is the world's most prestigious professional association for clinical laboratorians, clinical and molecular pathologists, and others in related fields. AACC's members are specialists trained in the areas of laboratory testing, including genetic disorders, infectious diseases, tumor markers and DNA. Their primary professional commitment is utilizing tests to detect, treat and monitor disease.
***Editor's Note: To schedule an interview with Dr. Rosen, please contact Donna Krupa at 703-527-7357 (direct dial), 703-967-2751 (cell) or djkrupa1@aol.com. Or contact the AACC Newsroom at: 215-418-2429. between 8:00 AM and 4:00 PM EST July 20-24, 2003.
AACC Newsroom
July 20-July 24, 2003
Pennsylvania Convention Center
Room: 303B
Telephone: 215-418-2429