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Men at osteoporosis risk should undergo BMD test

Osteoporosis is still considered a disease of older white women, but it is clear that both sexes and all ethnic groups have some risk for fracture.

Thus, even though women fracture more often, those men who experience hip fracture are vulnerable. Primary prevention entails finding those men at the highest risk and getting them to evaluation and treatment, explains Dr Adnan Abdulwahid, Rheumatologist, Zulekha Hospital, Sharjah.

While the risk for fracture in men increases with age, as it does in women, there is a subgroup of men who present in middle age, usually with vertebral fractures. Some of the men may have obvious secondary causes, such as glucocorticoid-induced osteoporosis. These men may have chronic obstructive pulmonary disease, inflammatory bowel disease, or a rheumatologic condition requiring oral glucocorticoids. In an important systematic review of reasons for low BMD (Bone Mineral Density) in older men, the following risk factors were found: Advancing age, low body weight, smoking, decreased physical activity and previous adult fracture.

Owing to the increasing fracture risk with aging, screening men in risk of osteoporosis by dual energy X-ray absorptiometry (DXA) of the spine and hip is advisable.

For the man who has suffered a fragility fracture or has osteoporosis determined by DXA, evaluation and treatment are indicated. However, in men as in women, there will be more fractures in those men who have so-called osteopenia on DXA testing simply because so many more men have osteopenia.

Men at increased risk for osteoporosis should undergo bone mineral density (BMD) testing using central dual-energy X-ray absorptiometry (DXA).

For men age 50 and above, one in five will experience an osteoporosis-related fracture in their lifetime. Risk factors for osteoporosis in men include age 70 years or older, low body weight, prior fracture as an adult, and smoking.

Specific recommendations include the followings:

> Men at higher risk for osteoporosis should undergo bone density testing using DXA, as well as laboratory testing to detect contributing causes.

> Recommended daily calcium intake for men who are at risk for osteoporosis is 1000 to 1200 mg. Ideally, dietary sources would suffice, but calcium supplements may be added if needed.

> Men at higher risk for osteoporosis should be encouraged to participate in weight-bearing exercise and to avoid smoking and excessive alcohol.

> Men with vitamin D levels lower than 30 ng/mL should receive vitamin D supplementation with a target level of 30 ng/mL or greater.

> Pharmacotherapy for osteoporosis is indicated for men at least 50 years of age with a history of spine or hip fractures, and for men at high risk for fracture resulting from low BMD (T-scores of −2.5 or below) and/or clinical risk factors.

> Selection of therapeutic agent should be individualized based on patient-specific factors including fracture history, severity of osteoporosis (T-scores), risk for hip fracture, patterns of BMD, comorbid conditions (such as peptic ulcer disease, gastroesophageal reflux, malabsorption syndromes, malignancy), cost, and other factors.

> To determine treatment response, clinicians should monitor BMD by serial DXA at the spine and hip every 1 to 2 years in men receiving pharmacotherapy for osteoporosis.

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