Vietnam Osteoporosis Workshop, HCM Cty 2006 OSTEOPOROSIS IN MEN Tuan Van Nguyen and Nguyen Dinh Nguyen Garvan Institute of Medical Research Sydney, Australia

Vietnam Osteoporosis Workshop, HCM Cty 2006 Background Generally unrecognized 20 yrs ago. An important public health problem. 30% of osteoporotic fractures occur in men.

Vietnam Osteoporosis Workshop, HCM Cty 2006 Skeleton development Peak bone mass closely tied to pubertal development. Male-female differences in the skeleton appear during adolescence. Peak bone mass achieved somewhat later in boys than girls. Trabecular bone: boys=girls Cortical bone: boys > girls The reasons for sex difference in skeleton development unclear, but could be related to sex steroid action.

Vietnam Osteoporosis Workshop, HCM Cty 2006 Prevalence of Osteoporosis US, men 50y+: 3% to 6% (vs % in women) (NHANES III, ). Canada, men 50y+: 2.9% at the lumbar spine and 4.8% at the femoral neck. (2001) By the year 2020: –Osteoporosis: 3.3 million Men –Osteopenia: 17.1 million Men

Vietnam Osteoporosis Workshop, HCM Cty 2006 Causes of Osteoporosis in Men Primary: –Aging –Idiopathic: unknown aetiology, possibly genetic factors more common in young men Secondary

Vietnam Osteoporosis Workshop, HCM Cty 2006 Secondary Osteoporosis in Men Hypogonadism Glucocorticoid excess Alcoholism, tobacco abuse Renal insufficiency Gastrointestinal, hepatic disorders, malabsorption Hyperparathyroidism Hypercalciuria Anticonvulsants Thyrotoxicosis Chronic respiratory disorders Anaemias, hemoglobinpathies Immobilization Osteoporosis imperfecta (OI) Homocystinuria Systemic mastocytosis Neoplastic diseases Rheumatoid arthritis

Vietnam Osteoporosis Workshop, HCM Cty 2006 Osteoporotic fracture in Men Lower incidence rates compared to women. 30% of osteoporotic fractures occur in men. Increased with advancing age. Increased with lower BMD. BMD-independent factors involved. Greater post-fracture mortality compared to those without fracture.

Vietnam Osteoporosis Workshop, HCM Cty 2006 Incidence of fracture in Men (Reproduced from Sander et al., 1999)

Vietnam Osteoporosis Workshop, HCM Cty 2006 Incidence of Hip fracture in Men

Vietnam Osteoporosis Workshop, HCM Cty 2006 Incidence of Vertebral fracture in Men (Adapted from The EPOS Groups, 2002)

Vietnam Osteoporosis Workshop, HCM Cty 2006 Incidence of Wrist fracture in Men (Reproduced from Melton et al., 1998)

Vietnam Osteoporosis Workshop, HCM Cty 2006 Incidence of other fractures

Vietnam Osteoporosis Workshop, HCM Cty 2006 Risk factors for fracture in Men Independent risk factors for any fracture in Men (Source: Nguyen TV et al., Am J Epidemiol, 1996;114:255-63)

Vietnam Osteoporosis Workshop, HCM Cty 2006 Risk factors for Hip fracture (Source: Nguyen ND et al., JBMR, 2005)

Vietnam Osteoporosis Workshop, HCM Cty 2006 Risk factors for incident Vert-fx (Source: van de Klift M et al., JBMR 2004;19: )

Vietnam Osteoporosis Workshop, HCM Cty 2006 Evaluation BMD in Men Guidelines for the evaluation of osteoporosis in men not well validated. Whether use T-scores based on a male- specific reference range or by using the same reference range used in women has been controversial.  Currently use a male-specific reference range is suggested.

Vietnam Osteoporosis Workshop, HCM Cty 2006 Indication for BMD testing Men 50y+ who have suffered a fracture including those with vertebral deformity. Younger men who suffer low trauma fractures. Men with secondary causes of bone loss, including men treated with glucocorticoids or other medications associated with osteoporosis.

Vietnam Osteoporosis Workshop, HCM Cty 2006 Laboratory testing Serum Ca, P, Creatinine, ALK, WBC. Liver function tests. Protein electrophoresis in those >50y. Serum 25(OH) vitamin D and PTH. Serum testosterone and liteinizing hormone. 24h urine calcium and creatinine Targeted diagnostic testing in men with signs, symptoms, or other indications of secondary disorders.

Vietnam Osteoporosis Workshop, HCM Cty 2006 Osteoporosis prevention in Men Similar to those in women Excellent nutrition and exercise Lifestyle Calcium and Vitamin D supplementations Increasing strength and balance Early identifying causes of secondary osteoporosis

Vietnam Osteoporosis Workshop, HCM Cty 2006 Lời Cảm tạ Chúng tôi xin chân thành cám ơn Công ty Dược phẩm Bridge Healthcare, Australia là nhà tài trợ cho hội thảo.

Vietnam Osteoporosis Workshop, HCM Cty 2006 Thank you!