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Slide 1 - OSTEOPOROSIS IN MEN Tuan Van Nguyen and Nguyen Dinh Nguyen Garvan Institute of Medical Research Sydney, Australia
Slide 2 - Background Generally unrecognized 20 yrs ago. An important public health problem. 30% of osteoporotic fractures occur in men.
Slide 3 - 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.
Slide 4 - Prevalence of Osteoporosis US, men 50y+: 3% to 6% (vs. 13-18% in women) (NHANES III, 1984-1994). 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
Slide 5 - Causes of Osteoporosis in Men Primary: Aging Idiopathic: unknown aetiology, possibly genetic factors more common in young men Secondary
Slide 6 - 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
Slide 7 - 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.
Slide 8 - Incidence of fracture in Men (Reproduced from Sander et al., 1999)
Slide 9 - Incidence of Hip fracture in Men
Slide 10 - Incidence of Vertebral fracture in Men (Adapted from The EPOS Groups, 2002)
Slide 11 - Incidence of Wrist fracture in Men (Reproduced from Melton et al., 1998)
Slide 12 - Incidence of other fractures
Slide 13 - 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)
Slide 14 - Risk factors for Hip fracture (Source: Nguyen ND et al., JBMR, 2005)
Slide 15 - Risk factors for incident Vert-fx (Source: van de Klift M et al., JBMR 2004;19:1172-80)
Slide 16 - 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.
Slide 17 - 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.
Slide 18 - 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.
Slide 19 - 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
Slide 20 - Lời Cảm tạ Chúng tôi xin chân thành cám ơn Công ty Dược phẩm Bridge Healthcare, Australia là nhà tài trợ cho hội thảo.
Slide 21 - Thank you!
 

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