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Osteologie 2013; 22(04): 260-266
DOI: 10.1055/s-0038-1630136
Osteoporosis in men
Schattauer GmbH

Male Osteoporosis

Secondary causesOsteoporose beim MannSekundäre Ursachen
B. C. Hanusch
1   Department of Trauma and Orthopaedics, Academic Centre, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
,
S. P. Tuck
2   Hon Senior Lecturer, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Department of Rheumatology, James Cook University Hospital, Marton Road, Middlesbrough, Cleveland, UK
,
R. M. Francis
3   Emeritus Professor of Geriatric Medicine, Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
› Author Affiliations
Further Information

Publication History

received: 30 September 2013

accepted: 01 October 2013

Publication Date:
30 January 2018 (online)

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Summary

Male osteoporosis is common and results in considerable morbidity and mortality. There are distinct differences in the normal aging of bone between the genders, which result in a lower fracture rate in men. Men who suffer from osteoporosis are much more likely than women to have secondary causes. The identification and treatment of these secondary causes, wherever possible, will result in substantial improvements in BMD. There is now evidence for use of many of the existing agents to treat osteoporosis in men. In younger hypogonadal men testosterone replacement is worth considering, but in older men especially the over sixties this is less effective and there is an increased risk of adverse cardiovascular and prostatic outcomes. Prostate cancer is an increasingly common cause, which is partially the result of the success of ADT. There is now good evidence for the use of bisphosphonates and denosumab in this group of patients. HIV, whilst not being specific to men, is an increasingly recognised cause of male osteoporosis. The reasons for this are multifactorial and some may well be attributable to the anti-retroviral therapy itself. There is emerging evidence of an increased fracture risk in HIV infected individuals. The bone loss can be prevented by the use of bisphosphonates.

Zusammenfassung

Osteoporose beim Mann ist häufig und resultiert in beträchtlicher Morbidität und Mortalität. Es bestehen ausgeprägte Unterschiede in den normalen Alterungsprozessen des Knochens zwischen Männern und Frauen, welche zu einer niedrigeren Frakturrate bei Männern führt. Bei Männern, die an Osteoporose leiden, liegen deutlich häufiger sekundäre Ursachen vor als bei Frauen. Die Diagnose und Behandlung dieser sekundären Ursachen führen zu einer deutlichen Besserung der Knochendichte. Es liegen inzwischen gute Studiendaten vor, die den Gebrauch gängiger Osteoporosemedikamente auch zur Behandlung von Osteoporose bei Männern unterstützen. Bei jüngeren hypogonadalen Männern sollte eine Testosteron-Substitutionsbehandlung erwogen werden, aber bei älteren Männern, insbesondere bei Männern über 60 Jahre, ist diese weniger effektiv und es besteht ein erhöhtes Risiko für Herz-Kreislauf- und Prostata-Erkrankungen. Prostatakrebs ist eine immer häufigere Ursache für Osteoporose beim Mann, welche zum Teil auf den erfolgreichen Einsatz der Antiandrogentherapie zurückzuführen ist. Wissenschaftliche Daten unterstützen die Anwendung von Bisphosphonaten und Denosumab in dieser Patientengruppe. HIV, wenn auch nicht spezifisch nur bei Männern, wird zunehmend als Ursache von Osteoporose bei Männern anerkannt. Die Gründe hierfür sind multifaktoriell und können zum Teil der antiretroviralen Therapie zugeschrieben werden. Studien deuten daraufhin, dass HIV-infizierte Patienten auch ein höheres Frakturrisiko haben. Diese Knochenverluste können durch Behandlung mit Bisphosphonaten verhindert werden.

Keywords

Male osteoporosis - secondary osteoporosis - bone loss - testosterone

Schlüsselwörter

Osteoporose beim Mann - sekundäre Osteoporose - Knochenverlust - Testosteron
 

  • References

  • 1 Van Staa TP. et al. Epidemiology of fractures in England and Wales. Bone 2001; 29: 517-522.
    CrossrefPubMedGoogle Scholar
  • 2 Pande I. et al. Bone mineral density, hip axis length and risk of hip fractures in men: results from the Cornwall hip fracture study. Osteoporosis Int 2000; 11: 866-870.
    CrossrefPubMedGoogle Scholar
  • 3 Tuck SP. et al. Femoral neck shaft angle in men with fragility fractures. J Osteoporosis. 2011 Article ID 903721: 7 pages.
    PubMedGoogle Scholar
  • 4 Tuck SP. et al. A case control study of sex steroids and bone turnover in men with symptomatic vertebral fractures. Bone 2008; 43 (6) 999-1005.
    CrossrefPubMedGoogle Scholar
  • 5 Bauer DC. et al. Biochemical markers of bone turnover, hip bone loss and fracture in older men: the MrOS study. J Bone Miner Res 2009; 24 (12) 2032-2038.
    CrossrefPubMedGoogle Scholar
  • 6 Szulc P, Delmas PD. Bone loss in elderly men: increased endosteal bone loss and stable periosteal apposition. The prospective MINOS study. Osteoporosis Int 2007; 18 (4) 495-503.
    Google Scholar
  • 7 Tuck SP. et al. Is distal forearm fracture in men due to osteoporosis?. Osteoporosis Int 2002; 13: 630-636.
    CrossrefPubMedGoogle Scholar
  • 8 Scane AC. et al. Case-control study of the pathogenesis and sequelae of symptomatic vertebral fractures in men. Osteoporosis Int 1999; 9: 91-97.
    CrossrefPubMedGoogle Scholar
  • 9 Black DM. et al. Proximal femoral structure and the prediction of hip fracture in men: a large prospective study using qCT. J Bone Miner Res 2008; 23: 1326-1333.
    CrossrefPubMedGoogle Scholar
  • 10 Sheu Y. et al. Bone strength measured by peripheral quantitative computed tomography and the risk of non-vertebral fractures: the osteoporotic fractures in men (MrOS) study. J Bone Miner Res 2011; 26: 63-71.
    CrossrefPubMedGoogle Scholar
  • 11 Johannesdottir F, Poole KE, Reeve J. et al. Distribution of cortical bone in the femoral neck and hip fracture: a prospective case-control analysis of 143 incident hip fractures; the AGES-REYKJAVIK study. Bone 2011; 48 (6) 1268-1276.
    CrossrefPubMedGoogle Scholar
  • 12 Mellstrom D. et al. Older men with low serum oestradiol and high serum SHBG have an increased risk of fractures. J Bone Miner Res 2008; 23 (10) 1552-1560.
    CrossrefPubMedGoogle Scholar
  • 13 Cancer research UK statistics. Available @ http://info.cancerresearchuk.org/cancerstats/types/prostate/
  • 14 Smith MR. et al. Low bone mineral density in hormone-naïve men with prostate carcinoma. Cancer 2001; 91: 2238.
    CrossrefPubMedGoogle Scholar
  • 15 Hussain SA. et al. Immediate dual energy X-ray absorptiometry reveals a high incidence of osteoporosis in patients with advanced prostate cancer before hormonal manipulation. BJU Int 2003; 92: 690.
    CrossrefPubMedGoogle Scholar
  • 16 Mistry R. et al. Lateral spine radiographs before androgen deprivation treatment detect a high incidence of undiagnosed vertebral fragility fractures in men with advanced prostate cancer. J Urol 2011; 186 (2) 474-480.
    CrossrefPubMedGoogle Scholar
  • 17 Melton 3rd LJ. et al. Fracture risk in men with prostate cancer: a population-based study. J Bone Miner Res 2011; 26 (8) 1808-1815.
    CrossrefPubMedGoogle Scholar
  • 18 Nishimura Y. et al. Smad5 and DPC4 are key molecules in mediating BMP-2-induced osteoblastic differentiation of the pluripotent mesenchymal precursor cell line C2C12. J Biol Chem 1998; 273 (4) 1872-1879.
    CrossrefPubMedGoogle Scholar
  • 19 Sanders N. et al. Ca 2+-sensing receptor expression and PTHrP secretion in PC38 human prostate cancer cells. Am J Physiol – Endocrinol Metabol 2001; 281 (6) E1267-E1274.
    Google Scholar
  • 20 Iwamura M. et al. Parathyroid hormone-related protein: a potential autocrine growth regulator in human cancer cell lines. Urology 1994; 43 (5) 675-679.
    CrossrefPubMedGoogle Scholar
  • 21 Sieber PR. et al. Bicalutamide 150 mg maintains bone mineral density during monotherapy for localised or locally advanced prostate cancer. J Urol 2004; 171: 2272-2276.
    CrossrefPubMedGoogle Scholar
  • 22 Smith MR. et al. Bicalutamide monotherapy versus leuprolide monotherapy for prostate cancer: effects on bone mineral density and body composition. J Clin Oncol 2004; 22: 2546-2553.
    CrossrefPubMedGoogle Scholar
  • 23 Gennari L. et al. Estrogen in men: effects on bone accrual, maintenance and prevention of bone loss. Expert Review of Endocrinology and Metabolism 2006; 1: 281-295.
    PubMedGoogle Scholar
  • 24 Smith MR. et al. Insulin sensitivity during combined androgen blockade for prostate cancer. J Clin Endocrinol Metab 2006; 91: 1305-1308.
    CrossrefPubMedGoogle Scholar
  • 25 Saigal CS. et al. Androgen deprivation therapy increases cardiovascular morbidity in men with prostate cancer. Cancer 2007; 110: 1493-1500.
    CrossrefPubMedGoogle Scholar
  • 26 Smith MR. Bisphosphonates to prevent osteoporosis in men receiving androgen deprivation therapy for prostate cancer. Drugs Aging 2003; 20: 175-183.
    CrossrefPubMedGoogle Scholar
  • 27 Wiren KM. et al. Transcriptional Up-Regulation of the Human Androgen Receptor by Androgen in Bone Cells. Endocrinol 1997; 138: 2291-2300.
    CrossrefPubMedGoogle Scholar
  • 28 Sunyer T. et al. Estrogen's bone-protective effects may involve differential IL-1 receptor regulation in human osteoclast-like cells. J Clin Invest 1999; 103 (10) 1409-1418.
    CrossrefPubMedGoogle Scholar
  • 29 Smith MR. et al. Sarcopenia during androgen-deprivation therapy for prostate cancer. J Clin Oncol 2012; 30 (26) 3271-3276.
    CrossrefPubMedGoogle Scholar
  • 30 Alibhai SMH. et al. Long-term side effects of androgen deprivation therapy in men with non-metastatic prostate cancer: a systematic literature review. Clinical Reviews in Oncology/Haematology 2006; 60: 201-215.
    Google Scholar
  • 31 Berruti A. et al. Changes in bone mineral density, lean body mass and fat content as measured by dual energy x-ray absorptiometry in patients with prostate cancer without apparent bone metastases given androgen deprivation therapy. J Urol 2002; 167: 2361-2367.
    CrossrefPubMedGoogle Scholar
  • 32 Smith MR. et al. Randomized controlled trial of zoledronic acid to prevent bone loss in men undergoing androgen deprivation therapy for nonmetastatic prostate cancer. J Urol 2003; 169: 2008-2012.
    CrossrefPubMedGoogle Scholar
  • 33 Shahinian VB. et al. Risk of fracture after androgen deprivation for prostate cancer. N Engl J Med 2005; 352: 154-164.
    CrossrefPubMedGoogle Scholar
  • 34 Hatano T. et al. Incidence of bone fracture in patients receiving luteinizing hormone-releasing hormone agonists for prostate cancer. BJU Int 2000; 86: 449-452.
    CrossrefPubMedGoogle Scholar
  • 35 Oefelein MG. et al. Skeletal fracture associated with androgen suppression induced osteoporosis: the clinical incidence and risk factors for patients with prostate cancer. J Urol 2001; 166: 1724-1728.
    CrossrefPubMedGoogle Scholar
  • 36 Melton III LJ. et al. Fracture risk following bilateral orchiectomy. J Urol 2003; 169: 1747-1750.
    CrossrefPubMedGoogle Scholar
  • 37 Dickman PW. et al. Hip fractures in men with prostate cancer treated with orchiectomy. J Urol 2004; 172: 2208-2212.
    CrossrefPubMedGoogle Scholar
  • 38 Abrahamsen B. et al. Fracture risk in Danish men with prostate cancer: a nationwide register study. BJUI 2007; 100: 749-754.
    CrossrefPubMedGoogle Scholar
  • 39 Thorstenson A. et al. Incidence of fractures causing hospitlisation in prostate cancer patients: results from the population-based PCBaSe Sweden. Eur J Cancer 2012; 48 (11) 1672-1681.
    CrossrefPubMedGoogle Scholar
  • 40 Smith MR. et al. Low bone density in hormone-naïve men with prostate carcinoma. Cancer 2001; 91 (12) 2238-2245.
    CrossrefPubMedGoogle Scholar
  • 41 Mccomsey et al. Bone Disease in HIV Infection: A Practical Review and Recommendations for HIV Care Providers. CLIN INFECT DIS 2010; 51 (8) 937-946.
    CrossrefPubMedGoogle Scholar
  • 42 Bonjoch et al. High prevalence of and progression to low bone mineral density in HIV-infected patients: a longitudinal cohort study. AIDS 2010; 24 (18) 2827-2833.
    CrossrefPubMedGoogle Scholar
  • 43 Walker-Bone K. Recognizing and treating secondary osteoporosis. Nat Rev Rheumatol 2012; 8 (8) 480-492.
    CrossrefPubMedGoogle Scholar
  • 44 Brown TT, Qaqish RB. Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review. AIDS 2006; 20 (17) 2165-2174.
    CrossrefPubMedGoogle Scholar
  • 45 Focà et al. Prospective evaluation of bone markers, parathormone and 1,25-(OH)2 vitamin D in HIV-positive patients after the initiation of tenofovir/emtricitabine with atazanavir/ritonavir or efavirenz. BMC Infectious Diseases 2012; 12 (1) 38.
    CrossrefPubMedGoogle Scholar
  • 46 Torti et al. High prevalence of radiological vertebral fractures in HIV-infected males. Endocrine 2012; 41 (3) 512-517.
    CrossrefPubMedGoogle Scholar
  • 47 Yong et al. Low CD4 count is associated with an increased risk of fragility fracture in HIV-infected patients. JAIDS Journal of Acquired Immune Deficiency Syndromes 2011; 57 (3) 205-210.
    CrossrefPubMedGoogle Scholar
  • 48 Planas J. et al. The relationship between daily calcium intake and bone mineral density in men with prostate cancer. BJU Int 2007; 99: 812-816.
    CrossrefPubMedGoogle Scholar
  • 49 Orwoll E. et al. Alendronate treatment of osteoporosis in men. New England Journal of Medicine 2000; 343: 604-610.
    CrossrefPubMedGoogle Scholar
  • 50 Greenspan SL. et al. Effect of oral alendronate on bone loss in men receiving androgen deprivation therapy for prostate cancer. Ann Intern Med 2007; 146: 416-424.
    CrossrefPubMedGoogle Scholar
  • 51 Pandya MB. et al. Recommendations for use of zoledronic acid for prevention and treatment of osteoporosis in men on androgen deprivation therapy for prostate cancer. J Clin Oncol. 2008 26. Abstract 1606.
    PubMedGoogle Scholar
  • 52 Michaelson MD. et al. Randomized control trial of annual zoledronic acid to prevent gonadotropin-releasing hormone agonist-induced bone loss in men with prostate cancer. J Clin Oncol 2007; 25: 1038-1042.
    CrossrefPubMedGoogle Scholar
  • 53 Smith MR. et al. Denosumab in men receiving androgen deprivation therapy for prostate cancer. N Eng J Med 2009; 361: 745-755.
    CrossrefPubMedGoogle Scholar
  • 54 Smith MR. et al. Effects of denosumab on bone mineral density in men receiving androgen deprivation therapy for prostate cancer. J Urol 2009; 182 (6) 2670-2675.
    CrossrefPubMedGoogle Scholar
  • 55 Lin D, Rieder MJ. Interventions for the treatment of decreased bone mineral density associated with HIV infection. Cochrane database of Systematic reviews. 2007 Issue 2 Art No: CD005645.
    PubMedGoogle Scholar
  • 56 Huang et al. A double-blinded, randomized controlled trial of zoledronate therapy for HIV-associated osteopenia and osteoporosis. AIDS 2009; 23 (1) 51-57.
    CrossrefPubMedGoogle Scholar
  • 57 Planas J. et al. Alendronate decreases the fracture risk in patients with prostate cancer on androgen-deprivation therapy and with severe osteopenia or osteoporosis. BJU Int 2009; 104 (11) 1637-1640.
    CrossrefPubMedGoogle Scholar
  • 58 Bruder JM. et al. Effects of alendronate on bone mineral density in men with prostate cancer treated with androgen deprivation therapy. J Clin Densitometry 2006; 9 (4) 431-437.
    CrossrefPubMedGoogle Scholar
  • 59 Taxel P. et al. Risedronate prevents early bone loss and increased bone turnover in the first 6 months of luteinizing hormone-releasing hormone-agonist therapy for prostate cancer. BJU Int 2010; 106 (10) 1437-1436.
    Google Scholar
  • 60 Ishizaka K. et al. Preventive effect of risedronate on bone loss in men receiving androgen-deprivation therapy for prostate cancer. Int J Urol 2007; 14 (12) 1071-1075.
    CrossrefPubMedGoogle Scholar
  • 61 Izumi K. et al. Risedronate recovers bone loss in patients with prostate cancer undergoing androgen-deprivation therapy. Urology 2009; 73 (6) 1342-1346.
    CrossrefPubMedGoogle Scholar
  • 62 Ryan CW. et al. Zoledronic acid initiated during the first year of androgen deprivation therapy increases bone mineral density in patients with prostate cancer. J Urol 2006; 176 (3) 972-978.
    CrossrefPubMedGoogle Scholar
  • 63 Israeli et al. The effect of zoledronic acid on bone mineral density in patients undergoing androgen deprivation therapy. Clin Genitourin Cancer 2007; 5 (4) 271-277.
    CrossrefPubMedGoogle Scholar
  • 64 Satoh T. Single infusion of zoledronic acid to prevent androgen deprivation therapy-induced bone loss in men with hormone-naïve prostate carcinoma. Cancer 2009; 115 (15) 3468-3474.
    CrossrefPubMedGoogle Scholar