Expert panel discusses osteoporosis in men

At the recently held Fifth International Conference on Osteoporosis in Men, an international panel of experts discussed clinical agreements and disagreements regarding progressive bone loss among men.

Among other consensuses reached by the group, researchers determined that the detection and treatment of male osteoporosis can be optimized through the use of standardized diagnostic procedures.

Their suggestions, which appear in the journal Osteoporosis International (OI), tended toward the use of a sole bone-density reference site, the femur neck, as well as of one testing method, which experts said should be the dual-energy x-ray absorptiometry (DXA) scan.

The use of DXA technology is already quite widespread among clinicians who test for bone loss. However, systematic bodily testing sites are not. Furthermore, doctors do not yet use one standard reference population - the group of people whose bone masses set the bar for good skeletal health - as a benchmark for bone levels.

In that regard, the study's authors suggested that physicians use as a reference the Third National Health and Nutrition Examination Survey, which was conducted by the Centers for Disease Control and Prevention between 1988 and 1994.

Part of the difficulty in diagnosing and treating osteoporosis in men is that studies establishing the effectiveness of certain tests and medications for this population are in relatively short supply.

Far more research has been conducted among females with the disease, which is not particularly surprising to those who know that progressive bone loss is more common among women than men.

Of the 10 million Americans suffering from osteoporosis, just 2 million are men, the National Osteoporosis Foundation (NOF) estimates.

That said, men with the disease are still at a substantial risk for broken bones, which are one of the leading causes of disability among elderly adults. Up to 25 percent of men over the age of 50 will experience an osteoporosis-related fracture in their lifetimes, according to the NOF.

Male osteoporosis has lately been the subject of an increasing number of studies, most of which aim, like the panel discussion, to establish the specifics of men's risk of, and response to treatment for, bone loss.

A report published in OI in 2009 determined that a handful of specific factors can help clinicians determine a man's risk of the disease.

These determinants included advanced age, low body mass index, a personal history of fractures, a family history of osteoporosis and the excess presence of C-terminal telopeptide, which is a bloodborne protein that indicates the rate of bone turnover in the body.

Another study, this one in the journal Best Practice and Research: Clinical Endocrinology and Metabolism, found that 50 percent of bone loss among men can be attributed to some other health problem, making half of all male osteoporosis diagnoses "secondary."

Likewise, its authors said that while the evidence is still slim, research suggests that certain pharmacological interventions - namely, bisphosphonates and teriparatide - appear to be as effective at increasing male bone density as they are for women.

The recently convened panel also noted that reducing the amount of bioavailable estrogen in the body has been shown to minimize bone loss and fracture risk among men, whereas testosterone replacement rarely has a place in the treatment of male osteoporosis.
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