[Osteoporosis in the aged male]

Abstract

A MAJOR PROBLEM: Osteoporosis in elderly men is a public health problem. However, the criteria for its diagnosis remain to be defined. With the aging of the male population, the number of osteoporotic fractures is increasing together with the incidence of fractures per age range. These fractures create handicaps and an excess of mortality and generate great expense for the health budget. VARIOUS PHYSIOPATHOLOGICAL MECHANISMS: In the pathogenesis of osteoporosis of the elderly men, various elements must be taken into account: hormone factors (decreased testicular secretion, vitamin D deficiency), life style (chronic alcoholism, smoking, lack of exercise), certain diseases (rheumatoid arthritis) and certain drugs (corticosteroids, anti-androgenes). THE PROGRESSION OF BONE MINERAL DENSITY (BMD) WITH AGE: Depending on the area measured, the BMD peak is reached before the age of 30 in the hip and in the trabecular bone areas, whilst it is reached around the age of 40 in the cortical bone areas. Bone loss accelerates after the age of 70. After the age of 80, the BMD peak is around 16 to 20% lesser, except for the lumbar spine where the arthrosic calcifications artificially increase the BMD value. Bone formation marker blood levels remain stable in elderly men whereas the urinary excretion of deoxypyridinoline (bone resorption marker) increases after the age of 60. THE DIAGNOSIS OF OSTEOPOROSIS IN ELDERLY MEN: Osteoporosis must be evoked when confronted with a recent fracture, notably of the vertebra, or following moderate trauma and the diagnosis is confirmed by the measurement of a low BMD score (T-score < -2.5). WITH REGARD TO TREATMENT: There are few studies on the treatment of male osteoporosis. In the elderly man, documented hypogonadism justifies testosterone replacement therapy, although its anti-fracture efficacy has not been studied. In elderly men, particularly those living in homes, vitamin D deficiency and the subsequent hyperthyroidism justify treatment with vitamin D and calcium. The new bisphosphonates appear promising. In a randomised study, alendronate increased BMD and reduced the incidence of vertebral fractures. Alendronate and risedronate were also effective in the prevention and treatment of cortisone-induced osteoporosis in men.