Copyright © 2013 Elsevier Inc. All rights reserved. Chapter 32 Osteoporosis in Men: Epidemiology, Pathophysiology, and Clinical Characterization Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.1 Average annual fracture incidence rate in males and females per 10,000 population, by age group. Source: Donaldson et al. (1990) [572]. Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.2 Age-specific and sex-specific incidence of radiographic vertebral, hip, and distal forearm fractures in Europe. Source: Sambrook and Cooper (2006), with permission [573]. 3 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.3 Annual age-standardized rates of hip fracture by sex per 100,000 person-years in Canada. There appears to be a gradual decline in fracture rates that may have become more accentuated since 1995. Source: Leslie et al. (2009), with permission [31]. 4 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.4 Annual numbers of hip fractures, unadjusted hip fracture rates, and age-standardized hip fracture rates per 100,000 person-years in Canada. Although the fracture rate had declined, the numbers of hip fractures has increased because of the expansion in the elderly population. Source: Leslie et al. (2009), with permission [31]. 5 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.5 Observed and expected race- and sex-specific survival following fracture of the hip, all ages combined. Source: Jacobson et al. (1992), with permission [574]. 6 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.6 Os calcis bone mineral content of men by 5-year age groups and grade of osteoporosis (n = 821). Each point and bar represents the mean and standard error of the mean (SE), respectively. Grade 0, normal (no radiographic evidence of vertebral demineralization or fracture). Grades 1–3, progressively severe vertebral demineralization and fracture. Source: Ross et al. (1988), with permission [89]. 7 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.7 Incidence of new vertebral fractures (1981–1994) among men and women in the Hawaii Osteoporosis Study (HOS), by quartiles of baseline calcaneus bone mineral density (BMD). Source: Ross et al. (1999), with permission [91]. 8 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.8 Axial cross-sectional area, transverse diameter, anteroposterior diameter, and vertebral body volume of the first (L1), second (L2), and third (L3) lumbar vertebral bodies in 12 pairs of men and women matched for age, vertebral body height, and bone density. Values are mean ± 1 standard deviation (SD) *p < 0.001. Values in men are shown by the open bars; values in women are shown by shaded bars. Source: Gilsanz et al. (1994), with permission [575]. 9 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.9 Bone mass gain at the lumbar spine during adolescence. The yearly increase in lumbar spine bone mineral density (BMD) (A) and bone mineral content (BMC) (B) is depicted in males and females (mean ± standard error of the mean (SE)). Source: Theintz et al. (1992), with permission [576]. 10 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.10 Mean yearly rate of change in bone mineral density (BMD) and 95% confidence interval according to age group and sex, the Rotterdam Study, The Netherlands, 1990-1995, p values are for linear trends. Source: Burger et al. (1998), with permission [141]. 11 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.11 Age-related changes in the calculated failure moment of male and female human femoral shafts in bending. The slope of the female data is significantly different from 0. Source: Martin (1993), with permission [138]. 12 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.12 Changes in trabecular number (solid lines) and trabecular width (dashed lines) with age in the iliac crest of men and women. Source: Aaron et al. (1987), with permission [193]. 13 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.13 The ratio of urinary pyridinoline (PYR) to urinary creatinine excretion (mean ± standard error of the mean (SE)) in 440 adults expressed as a percentage of values in young adults. Source: Kanis and Adami (1994), with permission [535]. 14 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.14 The associations between serum total and free estradiol levels and fracture risk in older Swedish men. Source: Mellstrom et al. (2008), with permission [297]. 15 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.15 The relationships between bone mineral density (BMD) of the lumbar spine, femoral neck, and femoral shaft and pubertal stages in male and female subject (* p < 0.05). SEM: standard error of the mean. Source: Bonjour et al. (1991), with permission [151]. 16 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.16 Changes in Va (dietary calcium absorption), Vbal (net calcium retention), and vo+ (rate of bone accretion) in prepubertal children treated with testosterone (n = 6). Solid bars, before testosterone; hatched bars, after testosterone. *p < 0.05. Source: Mauras et al. (1999), with permission [344]. 17 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.17 Radial bone mineral density in 23 men with a history of delayed puberty and 21 normal men. Source: Finkelstein et al. (1992), with permission [355]. 18 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.18 The time course of osteoblastic cell proliferation evaluated by deoxyribonucleic acid (DNA) synthesis in bone samples from osteoporotic men with low (open circles) or normal (open triangles) bone formation as determined by the extent of double-labeled surface, compared to normal bone cells (solid squares) (mean ± standard error of the mean (SE)). cpm: counts per minute. Source: Marie et al. (1991), with permission [315]. 19 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.19 Nonvertebral fracture risk and the combined effects of bone mineral density (BMD) and clinical factors. Fracture risk increases substantially as bone density decreases and the number of clinical factors that are associated with fracture increases. Source: Lewis et al. (2007), with permission [72]. 20 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.20 General approach to the diagnosis and evaluation of osteoporosis in men. BMD: bone mineral density; SD: standard deviation; W/U: work-up. Source: Orwoll (1999), with permission [536]. 21 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.21 Lumbar spine (A) and femoral neck (B) bone mineral density (BMD) in male subjects with and without vertebral deformity. Four grades of vertebral deformity are illustrated (anterior vertebral/posterior vertebral height ration of < 0.85, or < 0.80, and anterior vertebral heights < 2 standard deviations (SD) or < 3 SD of a population mean. Source: Mann et al. (1992), with permission [51]. 22 Copyright © 2013 Elsevier Inc. All rights reserved.
Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 32.22 Rate of change in bone mineral density (BMD) of lumbar spine during control or testosterone treatment periods (each of 6 months’ duration) in men receiving glucocorticoid therapy. Data are given as the mean ± standard error or the mean (SEM). There was a significant difference between groups (p = 0.05). The asterisk indicates a significant difference from 0 (p = 0.005). Source: Reid et al. (1996), with permission [566]. 23 Copyright © 2013 Elsevier Inc. All rights reserved.