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Clinical Orthopaedics and Related Research®

Erschienen in:

01.07.2011 | Symposium: AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium

Sex and Gender Considerations in Male Patients With Osteoporosis

verfasst von: Christopher J. Dy, MD, MSPH, Lauren E. LaMont, MD, Quang V. Ton, MD, Joseph M. Lane, MD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 7/2011

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Abstract

Background

Osteoporosis remains underrecognized and undertreated in both men and women, but men who sustain fragility fractures experience greater morbidity and mortality. While men exhibit advanced comorbidity at the time of hip fracture presentation, there are distinct sex- and gender-specific factors related to the pathophysiology and treatment of osteoporosis that further influence morbidity and mortality.

Questions/purposes

With a selective review of the literature, we evaluated sex- and gender-based differences contributing to increased morbidity and mortality in men with osteoporosis.

Where are we now?

Sex-specific differences in bone biology and morphology may affect the pathophysiology of osteoporosis, choice of pharmacotherapy, and surgical implant selection. Additionally, estrogen metabolism may play a key role in both fracture prevention and healing. Gender-based differences in recommendations for screening and prevention between men and women may influence the severity at which osteoporosis is recognized. Primary, secondary, and tertiary prevention efforts in men lag behind those of women. This may be due to a lack of consensus regarding screening guidelines for osteoporosis in men but may be attributed to lack of awareness in the physician and patient about osteoporosis and its potentially debilitating consequences.

Where do we need to go?

These disparities are a call to action for healthcare providers to raise awareness for early prevention and treatment of this potentially debilitating disease, particularly in men.

How do we get there?

Continued prospective research on the differences between men and women diagnosed with osteoporosis is needed, as well as sex-specific stratification of data in all studies on osteoporosis.

Al-Dabagh H, Archer J, Newton M, Kwagyan J, Nunlee-Bland G. Osteoporosis awareness protocol for patients with fragility fractures. J Natl Med Assoc. 2009;101:145–150.PubMed

Ali NS, Shonk C, El-Sayed MS. Bone health in men: influencing factors. Am J Health Behav. 2009;33:213–222.PubMed

American Academy of Family Physicians. Osteoporosis: information from your family doctor. Am Fam Physician. 2009;79:201–202.

Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Lewiecki EM, Silverman S. Official positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD position development conference. J Clin Densitom. 2008;11:75–91.PubMedCrossRef

Barrett-Connor E, Mueller JE, von Muhlen DG, Laughlin GA, Schneider DL, Sartoris DJ. Low levels of estradiol are associated with vertebral fractures in older men, but not women: The Rancho Bernardo Study. J Clin Endocrinol Metab. 2000;85:219–223.PubMedCrossRef

Beil FT, Barvencik F, Gebauer M, Seitz S, Rueger JM, Ignatius A, Pogoda P, Schinke T, Amling M. Effects of estrogen on fracture healing in mice. J Trauma. 2010;69:1259–1265.PubMedCrossRef

Carnevale V, Nieddu L, Romagnoli E, Bona E, Piemonte S, Scillitani A, Minisola S. Osteoporosis intervention in ambulatory patients with previous hip fracture: a multicentric, nationwide Italian survey. Osteoporos Int. 2006;17:478–483.PubMedCrossRef

Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. 1999;353:878–882.PubMedCrossRef

Chang KP, Center JR, Nguyen TV, Eisman JA. Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res. 2004;19:532–536.PubMedCrossRef

10.

Clarke BL, Khosla S. Physiology of bone loss. Radiol Clin North Am. 2010;48:483–495.PubMedCrossRef

11.

Cranney A, Tugwell P, Zytaruk N, Robinson V, Weaver B, Adachi J, Wells G, Shea B, Guyatt G; Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group. Meta-analyses of therapies for postmenopausal osteoporosis. IV. Meta-analysis of raloxifene for the prevention and treatment of postmenopausal osteoporosis. Endocr Rev. 2002;23:524–528.PubMedCrossRef

12.

de Groen PC, Lubbe DF, Hirsch LJ, Daifotis A, Stephenson W, Freedholm D, Pryor-Tillotson S, Seleznick MJ, Pinkas H, Wang KK. Esophagitis associated with the use of alendronate. N Engl J Med. 1996;335:1016–1021.PubMedCrossRef

13.

Delmas PD, Ensrud KE, Adachi JD, Harper KD, Sarkar S, Gennari C, Reginster JY, Pols HA, Recker RR, Harris ST, Wu W, Genant HK, Black DM, Eastell R; Multiple Outcomes of Raloxifene Evaluation Investigators. Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab. 2002;87:3609–3617.PubMedCrossRef

14.

Duschek EJ, Gooren LJ, Netelenbos C. Effects of raloxifene on gonadotrophins, sex hormones, bone turnover and lipids in healthy elderly men. Eur J Endocrinol. 2004;150:539–546.PubMedCrossRef

15.

Ebeling PR. Osteoporosis in men: new insights into aetiology, pathogenesis, prevention and management. Drugs Aging. 1998;13:421–434.PubMedCrossRef

16.

Ebeling PR. Clinical practice: osteoporosis in men. N Engl J Med. 2008;358:1474–1482.PubMedCrossRef

17.

Edwards BJ, Langman CB, Bunta AD, Vicuna M, Favus M. Secondary contributors to bone loss in osteoporosis related hip fractures. Osteoporos Int. 2008;19:991–999.PubMedCrossRef

18.

Exploring the biological contributions to human health: does sex matter? J Womens Health Gend Based Med. 2001;10:433–439.

19.

Feldstein AC, Nichols G, Orwoll E, Elmer PJ, Smith DH, Herson M, Aickin M. The near absence of osteoporosis treatment in older men with fractures. Osteoporos Int. 2005;16:953–962.PubMedCrossRef

20.

Fink HA, Ewing SK, Ensrud KE, Barrett-Connor E, Taylor BC, Cauley JA, Orwoll ES. Association of testosterone and estradiol deficiency with osteoporosis and rapid bone loss in older men. J Clin Endocrinol Metab. 2006;91:3908–3915.PubMedCrossRef

21.

Guggenbuhl P. Osteoporosis in males and females: is there really a difference? Joint Bone Spine. 2009;76:595–601.PubMedCrossRef

22.

Haaland DA, Cohen DR, Kennedy CC, Khalidi NA, Adachi JD, Papaioannou A. Closing the osteoporosis care gap: increased osteoporosis awareness among geriatrics and rehabilitation teams. BMC Geriatr. 2009 Jul 14;9:28.PubMedCrossRef

23.

Hochberg MC, Ross PD, Black D, Cummings SR, Genant HK, Nevitt MC, Barrett-Connor E, Musliner T, Thompson D. Larger increases in bone mineral density during alendronate therapy are associated with a lower risk of new vertebral fractures in women with postmenopausal osteoporosis: Fracture Intervention Trial Research Group. Arthritis Rheum. 1999;42:1246–1254.PubMedCrossRef

24.

Hodgson SF, Watts NB, Bilezikian JP, Clarke BL, Gray TK, Harris DW, Johnston CC Jr, Kleerekoper M, Lindsay R, Luckey MM, McClung MR, Nankin HR, Petak SM, Recker RR; AACE Osteoporosis Task Force. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Prevention and Treatment of Postmenopausal Osteoporosis: 2001 edition, with selected updates for 2003. Endocr Pract. 2003;9:544–564.PubMed

25.

Hofbauer LC, Hamann C, Ebeling PR. Approach to the patient with secondary osteoporosis. Eur J Endocrinol. 2010;162:1009–1020.PubMedCrossRef

26.

Iwamoto J, Takeda T, Sato Y, Uzawa M. Comparison of the effect of alendronate on lumbar bone mineral density and bone turnover in men and postmenopausal women with osteoporosis. Clin Rheumatol. 2007;26:161–167.PubMedCrossRef

27.

Johnell O, Kanis J, Gullberg G. Mortality, morbidity, and assessment of fracture risk in male osteoporosis. Calcif Tissue Int. 2001;69:182–184.PubMedCrossRef

28.

Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B. Excess mortality in men compared with women following a hip fracture: national analysis of comedications, comorbidity and survival. Age Ageing. 2010;39:203–209.PubMedCrossRef

29.

Kaufman JM, Orwoll E, Goemaere S, San Martin J, Hossain A, Dalsky GP, Lindsay R, Mitlak BH. Teriparatide effects on vertebral fractures and bone mineral density in men with osteoporosis: treatment and discontinuation of therapy. Osteoporos Int. 2005;16:510–516.PubMedCrossRef

30.

Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH. Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med. 2002;162:2217–2222.PubMedCrossRef

31.

Kolios L, Hoerster AK, Sehmisch S, Malcherek MC, Rack T, Tezval M, Seidlova-Wuttke D, Wuttke W, Stuermer KM, Stuermer EK. Do estrogen and alendronate improve metaphyseal fracture healing when applied as osteoporosis prophylaxis? Calcif Tissue Int. 2010;86:23–32.PubMedCrossRef

32.

Lenart BA, Neviaser AS, Lyman S, Chang CC, Edobor-Osula F, Steele B, van der Meulen MC, Lorich DG, Lane JM. Association of low-energy femoral fractures with prolonged bisphosphonate use: a case control study. Osteoporos Int. 2009;20:1353–1362.PubMedCrossRef

33.

McMillan J, Fatehi-Sedeh S, Sylvia VL, Bingham V, Zhong M, Boyan BD, Schwartz Z. Sex-specific regulation of growth plate chondrocytes by estrogen is via multiple MAP kinase signaling pathways. Biochim Biophys Acta. 2006;1963:381–392.CrossRef

34.

Morris CA, Cabral D, Cheng H, Katz JN, Finkelstein JS, Avorn J, Solomon DH. Patterns of bone mineral density testing: current guidelines, testing rates, and interventions. J Gen Intern Med. 2004;19:783–790.PubMedCrossRef

35.

Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mitlak BH. Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344:1434–1441.PubMedCrossRef

36.

Nelson HD, Haney EM, Chou R, Dana T, Fu R, Bougatsos C. Screening for Osteoporosis: Systematic Review to Update the 2002 U.S. Preventive Services Task Force Recommendation [Internet]. AHRQ Report Number 10-05145-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2010.

37.

Neviaser AS, Lane JM, Lenart BA, Edobor-Osula F, Lorich DG. Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma. 2008;22:346–350.PubMedCrossRef

38.

Nguyen TV, Eisman JA, Kelly PJ, Sambrook PN. Risk factors for osteoporotic fractures in elderly men. Am J Epidemiol. 1996;144:255–263.PubMed

39.

Orwoll E, Ettinger M, Weiss S, Miller P, Kendler D, Graham J, Adami S, Weber K, Lorenc R, Pietschmann P, Vandormael K, Lombardi A. Alendronate for the treatment of osteoporosis in men. N Engl J Med. 2000;343:604–610.PubMedCrossRef

40.

Orwoll ES, Scheele WH, Paul S, Adami S, Syversen U, Diez-Perez A, Kaufman JM, Clancy AD, Gaich GA. The effect of teriparatide [human parathyroid hormone (1–34)] therapy on bone density in men with osteoporosis. J Bone Miner Res. 2003;18:9–17.PubMedCrossRef

41.

Pazianas M, Miller P, Blumentals WA, Bernal M, Kothawala P. A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonates: prevalence, risk factors, and clinical characteristics. Clin Ther. 2007;29:1548–1558.PubMedCrossRef

42.

Penzkofer R, Maier M, Nolte A, von Oldenburg G, Puschel K, Buhren V, Augat P. Influence of intramedullary nail diameter and locking mode on the stability of tibial shaft fracture fixation. Arch Orthop Trauma Surg. 2009;129:525–531.PubMedCrossRef

43.

Pols HA, Felsenberg D, Hanley DA, Stepan J, Munoz-Torres M, Wilkin TJ, Qin-sheng G, Galich AM, Vandormael K, Yates AJ, Stych B; Fosamax International Trial Study Group. Multinational, placebo-controlled, randomized trial of the effects of alendronate on bone density and fracture risk in postmenopausal women with low bone mass: results of the FOSIT study. Osteoporos Int. 1999;9:461–468.PubMedCrossRef

44.

Raz P, Nasatzky E, Boyan BD, Ornoy A, Schwartz Z. Sexual dimorphism of growth plate prehypertrophic and hypertrophic chondrocytes in response to testosterone requires metabolism to dihydrotestosterone (DHT) by steroid 5-alpha reductase type 1. J Cell Biochem. 2005;95:108–119.PubMedCrossRef

45.

Ringe JD, Farahmand P, Faber H, Dorst A. Sustained efficacy of risedronate in men with primary and secondary osteoporosis: results of a 2-year study. Rheumatol Int. 2009;29:311–315.PubMedCrossRef

46.

Ringe JD, Orwoll E, Daifotis A, Lombardi A. Treatment of male osteoporosis: recent advances with alendronate. Osteoporos Int. 2002;13:195–199.PubMedCrossRef

47.

Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J; Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002;288:321–333.PubMedCrossRef

48.

Sakuma M, Endo N, Oinuma T, Hayami T, Endo E, Yazawa T, Watanabe K, Watanabe S. Vitamin D and intact PTH status in patients with hip fracture. Osteoporos Int. 2006;17:1608–1614.PubMedCrossRef

49.

Sawka AM, Papaioannou A, Adachi JD, Gafni A, Hanley DA, Thabane L. Does alendronate reduce the risk of fracture in men? A meta-analysis incorporating prior knowledge of anti-fracture efficacy in women. BMC Musculoskelet Disord. 2005;6:39.PubMedCrossRef

50.

Seeman E. Clinical Review 137: Sexual dimorphism in skeletal size, density, and strength. J Clin Endocrinol Metab. 2001;86:4576–4584.PubMedCrossRef

51.

Shackelford DP, Lalikos JF. Estrogen replacement therapy and the surgeon. Am J Surg. 2000;179:333–336.PubMedCrossRef

52.

Shane E, Burr D, Ebeling PR, Abrahamsen B, Adler RA, Brown TD, Cheung AM, Cosman F, Curtis JR, Dell R, Dempster D, Einhorn TA, Genant HK, Geusens P, Klaushofer K, Koval K, Lane JM, McKiernan F, McKinney R, Ng A, Nieves J, O’Keefe R, Papapoulos S, Sen HT, Van Der Meulen MC, Weinstein RS, Whyte M; American Society for Bone and Mineral Research. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2010;25:2267–2294.PubMedCrossRef

53.

Silverman SL, Cummings SR, Watts NB; Consensus Panel of the ASBMR, ISCD, and NOF. Recommendations for the clinical evaluation of agents for treatment of osteoporosis: consensus of an expert panel representing the American Society for Bone and Mineral Research (ASBMR), the International Society for Clinical Densitometry (ISCD), and the National Osteoporosis Foundation (NOF). J Bone Miner Res. 2008;23:159–165.PubMedCrossRef

54.

Smith EP, Boyd J, Frank GR, Takahashi H, Cohen RM, Specker B, Williams TC, Lubahn DB, Korach KS. Estrogen resistance caused by a mutation in the estrogen-receptor gene in a man. N Engl J Med. 1994;331:1056–1061.PubMedCrossRef

55.

Stuermer EK, Sehmisch S, Rack T, Wenda E, Seidlova-Wuttke D, Tezval M, Wuttke W, Frosch KH, Stuermer KM. Estrogen and raloxifene improve metaphyseal fracture healing in the early phase of osteoporosis: a new fracture-healing model at the tibia in rat. Langenbecks Arch Surg. 2010;395:163–172.PubMedCrossRef

56.

Szulc P, Munoz F, Claustrat B, Garnero P, Marchand F, Duboeuf F, Delmas PD. Bioavailable estradiol may be an important determinant of osteoporosis in men: the MINOS study. J Clin Endocrinol Metab. 2001;86:192–199.PubMedCrossRef

57.

Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007;370:657–666.PubMedCrossRef

58.

Tosi LL, Boyan BD, Boskey AL. Does sex matter in musculoskeletal health? The influence of sex and gender on musculoskeletal health. J Bone Joint Surg Am. 2005;87:1631–1647.PubMedCrossRef

59.

Ward KA, Pye SR, Adams JE, Boonen S, Vanderschueren D, Borghs H, Gaytant J, Gielen E, Bartfai G, Casanueva FF, Finn JD, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Labrie F, Lean ME, Pendleton N, Punab M, Silman AJ, Wu FC, O’Neill TW; The EMAS Study Group. Influence of age and sex steroids on bone density and geometry in middle-aged and elderly European men. Osteoporos Int. 2010 October 30 [Epub ahead of print].

60.

Wells JC. Sexual dimorphism of body composition. Best Pract Res Clin Endocrinol Metab. 2007;21:415–430.PubMedCrossRef

Titel: Sex and Gender Considerations in Male Patients With Osteoporosis
verfasst von: Christopher J. Dy, MD, MSPH
Lauren E. LaMont, MD
Quang V. Ton, MD
Joseph M. Lane, MD
Publikationsdatum: 01.07.2011
Verlag: Springer-Verlag
Erschienen in: Clinical Orthopaedics and Related Research® / Ausgabe 7/2011
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-1849-3

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Questions/purposes

Where are we now?

Where do we need to go?

How do we get there?

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