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26-01-2012 | Endocrinology | Article

Risk factors for male osteoporosis identified


Free abstract

MedWire News: Several well-established risk factors for osteoporosis in women do not predict osteoporotic fracture in men, a study of male veterans has found.

The authors say that more work is needed to more accurately define risk factors for male osteoporosis and warn clinicians not to rely solely on clinical risk factors when assessing men for fracture risk.

The research was undertaken by Richard Nelson's group at the University of Utah, USA, and included 34,282 men in the Veterans Health Administration system in the Rocky Mountain region of the USA.

All men were aged 70 years and above at enrollment and were followed up for a median of 2.8 years for the primary endpoint, which was the clinical identification of either osteoporosis or fracture risk.

This endpoint - defined as osteoporosis diagnosis, prescription of calcitonin, parathyroid hormone, or a bisphosphonate, or bone mineral density testing - was met by 1249 men (3.64%). The average time to the endpoint was 1.4 years.

For their analyses, Nelson's group divided the men into two groups: those with at least one primary care visit in the 2 years before enrollment (n=9037), and those with only secondary care visits (n=25,245).

In the primary care group, multivariate analysis identified several significant predictors for the primary endpoint. The three strongest risk factors were exposure to gonadatropin-releasing hormone (hazard ratio [HR]=2.8), a history of fragility fracture (HR=2.4), and diagnosis of rheumatoid arthritis (HR=2.0).

Other, weaker predictors were underweight or normal weight, histories of cancer, deep vein thrombosis, falls, or malnutrition disorder, and exposure to glucocorticoids, loop diuretics, and opioids.

Interestingly, race, age, smoking, and alcohol abuse did not predict the endpoint.

In the secondary care group, the same three factors were significantly associated with the primary endpoint: gonadatropin-releasing hormone use (HR=4.1), fragility fractures (HR=3.0), and rheumatoid arthritis (HR=2.0). Others risk factors included underweight/normal weight, diagnoses of cancer, seizures, or thyroid disease, and exposure to antidepressants, glucocorticoids, histamine receptor antagonists, and opioids.

Again, however, race, age, smoking, and alcohol abuse did not predict the endpoint.

The latter factors are widely considered to be risk factors for osteoporosis, note Nelson et al.

Writing in Bone, they conclude: "The results of this study suggest that treatment and testing decisions can be better aligned with risk factors for osteoporosis fractures…

"Future work should focus on helping clinicians identify patients with high risk for fracture."

By Joanna Lyford

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