Osteoporosis
Osteoporosis is a metabolic bone disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk.”
Bone loss or osteoporosis is an often unrecognized but an important step in prevention. While osteoporotic fractures are more common in women, 25 to 30% of all hip fractures occur in men. Bone remodeling is a process that continues throughout life, long after we have stopped growing in height.
The relatively lower rate of osteoporosis in men compared to women is likely attributable to multiple factors, and may include larger bone size and thicker cortices in men. Also men live shorter lives. Women are likely to have a lower BMD than age-matched men. For example, the mean femoral neck BMD for women age 60 to 69 is comparable to that of men over age 80.
Men & women in their mid lives and beyond often have undiagnosed osteoporosis, and this is often associated with hormonal loss with aging.
Diagnosis of Osteoporosis
DEXA scans are performed to diagnose osteopenia and osteporosis. The World Health Organization (WHO) has determined BMD values indicative of osteoporosis specifically in reference to postmenopausal Caucasian women. As BMD values have not yet been specifically validated by correlation with fracture risk in men, the WHO criteria for diagnosing osteoporosis in women is often applied to men as well. The established female diagnostic criteria of a T-score of < –2.5 tends to underestimate osteoporosis prevalence in men, and clinical correlation may be needed.
When osteoporosis is present on DEXA (T – < -2.5), we evaluate for secondary causes, and guide treatment from these results. If an underlying cause is identified, then that must be treated first, and subsequently pharmacologic therapy for osteoporosis started. Patients with history of a fracture resulting from minimal or no trauma are defined as osteoporotic regardless of BMD and evaluated for secondary causes. Different pharmacologic management is advised in our therapeutic strategies at OPAL and may include non-hormonal and hormonal treatments. Loss of bone is associated with andropause and menopause, and patients will be advised about prevention accordingly.
