Gender Differences in Osteoporosis: A Single-Center Observational Study

Abstract

Purpose: Osteoporosis affects more than 200 million people worldwide: its prevalence increases with age and is actually growing due to the constant population aging. Women are at greater risk than men, but in recent years it has become increasingly evident that osteoporosis represents a significantly important problem also for men. However, osteoporosis in men is still poorly studied, underdiagnosed and inadequately treated.

Materials and methods: We conducted an observational study to identify any gender disparities in osteoporosis screening. For this purpose we observed people consecutively admitted at our Outpatient Service for the Diagnosis of Osteoporosis during the last 3 years. Patients underwent clinical and laboratory assessment and bone mineral density (BMD) measurements by dual-energy X-ray absorptiometry. Bone turnover serum markers have been evaluated and stratified according to gender.

Results: Out of 3,752 patients, 2,376 subjects who met the inclusion criteria were identified. As expected, the great majority (94.5%) of the screened subjects were women and only 5.4% were men. Women exhibited lower BMD compared to men (T-score values: -2.33±1.14 vs. -1.31±1.55; p<0.001), whereas the prevalence of fractures in osteoporotic men was significantly higher (50% vs. 31%; p<0.001). Women had lower vitamin D and higher bone remodeling markers compared to men. Secondary osteoporosis was more frequent in men (66.67%) than in women (20.83%) and the calculated risk for hip fractures was higher in osteoporotic men compared to women (11.47±10.62 vs. 6.87±7.73; p<0.001).

Conclusions: Here we highlighted that men are under-screened for osteoporosis and exhibit secondary osteoporosis more frequently than women.

Keywords: Aging; Bone; Bone density; Gender; Men; Osteoporosis.

Fig. 1. Gender distribution of the population admitted for the first time to the outpatient service for the diagnosis and treatment of osteoporosis within 3 years.

Fig. 2. T-score mean values in men and women (A) as well as in normal, osteopenic, and osteoporotic subjects in both genders (B).

Fig. 3. Gender differences in the distribution of normal, osteopenic, and osteoporotic subjects in people undergoing screening. ns: not significant.

Fig. 4. Proportions of fractured and unfractured men and women.

Fig. 5. Proportion (%) of fractured (F) and non fractured (NF) osteoporotic (T-score<−2.5), osteopenic (T-score ranging from −1.0 to −2.5), and normal (T-score > −1.0) women (A) and men (B).

Fig. 6. Prevalence of secondary osteoporosis (osteoporosis caused or exacerbated by undelying diseases or medication exposures in men and women). Twenty four out of 36 osteoporotic men (66.67%) and 240 out of 1,152 osteoporotic women (20.83%) suffered from secondary osteoporosis.