IOF World Congress on Osteoporosis

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MAY 12, 2002

Lisboa Congress Center, Portugal

Male osteoporosis: mechanisms and treatment reviewed

While osteoporosis has long been recognized as a common and serious disease affecting older women, its effects on men are only now coming into the spotlight.

Although osteoporotic hip fractures are less common in men, who account for only one in three patients with this type of break, the consequences are often more severe. Men suffer greater disability and morbidity in the wake of a hip fracture, and are more likely to die as a result of the break than their female counterparts. The reasons for these differences are still not completely understood, although several hypotheses have been proposed and are the subject of discussion at the ongoing IOF World Congress on Osteoporosis.

Tobacco use, excess alcohol intake, genetic factors and testosterone deficiency have long been recognized as risk factors for osteoporosis in men. More recent research has identified the female hormone estrogen as a key player in male as well as female osteoporosis, and has opened the door to new treatment options for male patients.

New information on male osteoporosis was reported during several oral presentations. Dr. P. Szulc and colleagues from Johns Hopkins Outpatient Center in Baltimore, USA and INSERM in Lyon, France reported data from the 934-patient MINOS study which suggest that in men, the "male" hormone testosterone acts as a weak stimulant of bone formation and the "female" hormone estrogen acts as an inhibitor of bone resorption. Testosterone is metabolized into estrogen via the effects of the enzyme aromatase, with the balance shifting gradually in favor of estrogen as a normal process of aging. Italian researchers have reported, on the basis of a longitudinal study in 200 elderly men, that the ratio between testosterone and estrogen was higher in normal versus osteoporotic men. This indicates that aromatization, the process of estrogen production from testosterone, plays a key role in regulating bone metabolism in elderly men.

Another important stimulant of bone turnover in men during the period of young adulthood, and to a much greater degree than in women, is the growth factor IGF-1 (insulin-like growth factor-1), according to Dr. Y.M. Henry and colleagues at the University of Sheffield, U.K.

The risk of bone fracture in men has been linked to trabecular bone connectivity, especially in men with low bone mineral density (BMD). Risk factors for disorganization of the bone microarchitecture include cigarette smoking, low body mass index (BMI), hypogonadism and chronic diseases. Men with one or more of these risk factors and with low BMD appear to be at greatest risk of suffering bone fractures.

In spite of the many gender-related differences in osteoporosis disease pathology described above, other studies have confirmed that similarities also exist. A team from the Netherlands' Erasmus University has demonstrated that, although the average hip fracture risk is lower for men than for women, men do appear to have a similar risk of hip fracture at the same absolute BMD. Thus the same absolute BMD thresholds used to make decisions about therapeutic intervention in women are also valid for men.

Current estimates are that 14 million men and 30 million women in the U.S. alone are at risk for osteoporosis and low bone mass. The lifetime risk of osteoporotic hip fracture in men is 13% greater than the risk of prostate cancer, and the incidence of osteoporotic fractures is expected to double in the next 50 years. By the year 2050, the number of osteoporotic hip fractures in men will equal the number seen in women at this time. Significantly the incidence of spinal fractures, which are reported less frequently than hip fractures but which may have greater impact on morbidity and mortality, is comparable among men and women.

The International Osteoporosis Foundation (IOF) is a worldwide organization dedicated to the fight against osteoporosis around the world. It brings together scientists, physicians, patient societies and corporate partners. Working hand in hand with its 139 member societies in 71 countries and other healthcare-related organizations around the world, IOF encourages awareness and prevention, early detection and improved treatment of osteoporosis.

The IOF World Congress on Osteoporosis is being held May 10-14, 2002 in Lisbon, Portugal. Some 5,000 participants are expected for the congress, expected to be the largest gathering ever of osteoporosis specialists from around the world. Abstracts from the congress are published in a supplementary volume of the journal Osteoporosis International. For more information visit the congress website:

IOF World Congress on Osteoporosis abstracts can be accessed on:

IOF website:

For more information contact Siofra Sharpe:

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