Abstract
The goal of this research project was to present a clinical cross section of osteoporosis in men utilizing a male patient collective that was referred to the bone densitometry section in a university hospital setting of a mid European capital. Although this bone densitometry section was primarily used as a research facility to which next to regular clinic patients, study subjects where referred, the distribution of referral diagnosis, that could lead to secondary osteoporosis, where similar to that described in the literature. Secondary causes for the development of osteoporosis such as corticosteroid therapy, hormonal changes leading to testosterone deficiency, malabsorbtion disorders and hypercortisolism due to disorders of the anterior pituitary gland were seen in the majority of the cases. 20.9% of the patients (the largest group) in this study suffered from gastrointestinal disorders. In the literature idiopathic osteoporosis was described as the most common cause of osteoporosis in men, followed be steroid induced- and testosterone deficiency osteoporosis. Since this bone densitometry facility is located in a university hospital setting the analysed cross section of this patient collective is not representative of the entire population.
In a group of marathon runners, whose mean age was younger than that of the entire patient collective, a 30.2% higher bone mineral density of the trabecular lumbar spine- and an 18.2% higher bone mineral density in the calcaneus in comparison with the entire patient group were found. This observation suggests that physical activity on a moderate training level can have a positive effect on the bone mineral density of men.
Assessing the bone mineral density status of 301 men using three different densitometry techniques showed differing results. In summary the diagnosis of osteoporosis in all of 238 men with osteoporosis who were not subjects of epidemiological clinical trials could be confirmed in 32% using QCT of the lumbar spine (76/238)-, in 57.8% using SPA in the calcaneus (129/223)- and in 7.5% using pQCT in the distal radius. The densitometry results at the three measurement sites using the three different techniques correlated moderately with each other (correlation coefficient trabecular lumbar spine / calcaneus R = 0.66; trabecular lumbar spine / trabecular distal radius R = 0.53). Consequently the bone mineral density at one skeletal site does not determine the bone mineral density of another skeletal site. The QCT method is considered the gold standard of all densitometry techniques because it enables a separate analysis of cortical and trabecular bone. The SPA method of measuring the calcaneus could not establish itself on a broad scale. In contrast the pQCT method for measuring extremities has found international acceptance. In most publications on the diagnosis of osteoporosis methods measuring bone mineral density at central skeletal sites (lumbar spine and proximal femur) are preferred. The most widely used method is DXA. The WHO definition of osteoporosis is based on DXA measurement results. All of the described densitometry techniques lack an internationally validated T- score system for males on which therapeutic decisions can be based. The high prevalence of osteoporosis in men, as is was shown in this work and as it has been described in the literature, underscores the need for large clinical trails to develop uniform diagnostic guidelines and evidence based therapeutic regimes for the diagnosis and treatment of osteoporosis in men.
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