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OSTEOPOROSIS: IT STRIKES MEN TOO

Research presented at the IOF World Congress on Osteoporosis focuses on role of vitamin D and risedronate to build bone density in men, and identifies treatment compliance problems specific to men.

RIO DE JANEIRO, Brazil
May 18, 2004

Research studies from France and Germany, presented at the IOF World Congress on Osteoporosis in Rio de Janeiro, support the use of vitamin D and the drug risedronate in men at risk of bone fractures.

However, a study from Venezuela finds that most men with osteoporosis stop taking their medications within a few months, highlighting the need to pay special attention to the differences between how men and women seek medical treatement.

Osteoporosis in men-a hidden problem

Men at all ages can fall victim to catastrophic weakening of their bones. Indeed, it is estimated that up to one in five men over fifty are at risk of developing osteoporosis during their lifetime, yet few men are aware of the threat. For this reason, IOF has determined that the theme for World Osteoporosis Day 2004, held on October 20, will be "Osteoporosis in Men."

Although osteoporosis in men is generating increased public awareness, research on osteoporosis-related male biology, diagnosis and treatment lags behind that done for women. "Osteoporosis in men is under-studied and under-reported," said Prof. John Bilezikan of Columbia University School of Medicine in New York City. "Only four percent of the literature on osteoporosis refers to the disease in men."

One cause for hope in this area is the revolution in genomics research. At the IOF-WCO, scientists from Switzerland and France reported on a gene associated with an increased risk for low bone mineral density and osteoporotic fracture in men (conference abstract OC37, described in more detail in a separate press release on osteoporosis-related genes).

When vitamin D drops, bones suffer

A large study of men over the age of 50 finds that low vitamin D levels are a risk factor for accelerated bone loss, a consequence that likely increases the risk of fractures.

Men's bones are at risk from vitamin D deficiency, according to the study presented by Dr. Pawel Szulc of INSERM 403 Unit in Lyon, France (conference abstract OC9). In the MINOS study, led by Prof. Pierre D. Delmas, president of the IOF, Szulc and his fellow researchers have followed approximately 700 men aged 50 to 85 for an average of almost five years, trying to gauge whether vitamin D levels can affect the pace of bone loss.

The study is important, according to Szulc, not only because it focuses on men, but because these men are living at home and moving about on their own. "Previous studies have typically studied women, often living in institutional settings," said Szulc.

The researchers found that in this population vitamin D deficiency was indeed a risk factor for accelerated bone loss. "In men who had blood levels of vitamin D below 25 micrograms per millilitre, the rate of bone loss was about twice as high as that in men whose vitamin D levels were above this threshold value," said Szulc.

"These data confirm the utility, or even necessity, of measuring vitamin D concentration in elderly men, especially in men older than 70, and in men with low bone mineral density irrespective of their age," said Szulc. "The results also suggest indirectly that vitamin D and calcium supplementation may be useful in the prevention of the accelerated bone loss in elderly men."

Risedronate builds bone density, reduces fractures in men

Another study presented at the IOF World Congress on Osteoporosis in Rio de Janeiro, Brazil, showed the benefits for men of a common osteoporosis drug still approved only for women.

While alendronate is currently the only bisphosphonate drug approved for treating osteoporosis in men, another bisphosphonate-risedronate-may be poised to join in.

Researchers in Germany, led by Dr. Johann D. Ringe of the University of Cologne's Teaching Hospital in Leverkusen, compared the effects of risedronate plus calcium and vitamin D, against a control regimen of only calcium and vitamin D (conference abstract OC43). The trial involved 318 men with osteoporosis, some of whom had already suffered vertebral fractures.

Ringe reported substantial benefits in the risedronate group after one year. Bone mineral density had increased significantly in the spine and femur at a rate similar to results seen in risedronate treatment of postmenopausal women with osteoporosis. In addition, the researchers noted that only 5 percent of the risedronate-treated men suffered new vertebral fractures, compared to 12.7 percent in the control group.

"From our data we conclude that risedronate is also highly effective in men with osteoporosis," said Ringe. "Another international multicenter trial studying risedronate in male osteoporosis will soon be finished and hopefully will also confirm the efficacy in men."

Venezuelan study finds men do not follow treatment regimen

Within months of beginning treatment for low bone mass, most men have stopped taking their medications, according to one of the few studies of osteoporosis in Latin American men (conference abstract P262SA).

Collaborating researchers from several institutions in Venezuela followed up on 160 men diagnosed with osteopenia (low bone density) or osteoporosis (severely low bone density). First author Milko Vitalle Donello of the University of Carabobo and colleagues found that within six months after diagnosis, 75 percent of the men had stopped treatment. "This is really a problem because it can take up to two years of treatment to see an effect with current medications," said coauthor Prof. Gregorio Riera Espinoza.

The dropout rate is much higher than that seen in other chronic diseases, such as diabetes or hypertension. Beyond the global perception that osteoporosis is a woman's disease, men in Latin American cultures may be especially reluctant to follow treatment for the disease, said Riera Espinoza, an IOF Board member.

Except for the compliance problem, the results from Venezuela paralleled those from other other areas of the world. For example, the main risk factors for the men in the study were a sedentary lifestyle, low calcium intake, and smoking.

It is noteworthy that almost half the cases of osteoporosis in men -- in Venezuela as elsewhere -- have identifiable causes, compared to only about twenty-five percent in women, said Riera Espinoza. Among the identifiable causes seen most often in men are alcoholism, hormonal disorders, and treatment with oral corticosteroids for other medical conditions such as rheumatoid arthritis, inflammatory bowel disease, and lung diseases.

For more information about the IOF World Congress on Osteoporosis, and to read the abstracts of presentations please visit: www.osteofound.org

ENDS

The International Osteoporosis Foundation (IOF) is a worldwide organization dedicated to the fight against osteoporosis. It brings together scientists, physicians, patient societies and corporate partners. Working with its 165 member societies in more than 85 locations, and other healthcare-related organizations around the world, IOF encourages awareness and prevention, early detection and improved treatment of osteoporosis.

Osteoporosis, in which the bones become porous and break easily, is one of the world's most common and debilitating diseases. The result: pain, loss of movement, inability to perform daily chores, and in many cases, death. One out of three women over 50 will experience osteoporotic fractures, as will one out of eight men(1). Unfortunately, screening for people at risk is far from being a standard practice. Osteoporosis can, to a certain extent, be prevented, it can be easily diagnosed and effective treatments are available.

1 Melton U, Chrischilles EA, Cooper C et al. How many women have osteoporosis? Journal of Bone Mineral Research, 1992; 7:1005-10

For more information on the IOF World Congress on Osteoporosis, including access to all the abstracts and press releases, please refer to: www.osteofound.org

Find out if you are at risk, take the IOF One Minute Risk Test at: www.osteofound.org

For further information, please contact
Paul Spencer Sochaczewski, Head of Communications,
International Osteoporosis Foundation:

Tel. +41 22 994 0100
Fax. +41 22 994 0101
E-mail: psochaczewski@osteofound.org

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