Guidelines of the Brazilian Society of Rheumatology for the diagnosis and treatment of osteoporosis in men (original) (raw)
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Osteoporosis in Men: A Review of an Underestimated Bone Condition
International Journal of Molecular Sciences, 2021
Osteoporosis is called the ‘silent disease’ because, although it does not give significant symptoms when it is not complicated, can cause fragility fractures, with serious consequences and death. Furthermore, the consequences of osteoporosis have been calculated to weigh heavily on the costs of health systems in all the countries. Osteoporosis is considered a female disease. Actually, the hormonal changes that occur after menopause certainly determine a significant increase in osteoporosis and the risk of fractures in women. However, while there is no doubt that women are more exposed to osteoporosis and fragility fractures, the literature clearly indicates that physicians tend to underestimate the osteoporosis in men. The review of the literature done by the authors shows that osteoporosis and fragility fractures have a high incidence also in men; and, furthermore, the risk of fatal complications in hip fractured men is higher than that for women. The authors report the evidence of...
Osteoporosis International, 2009
The Brazilian Osteoporosis Study (BRAZOS) is the first epidemiological study carried out in a representative sample of Brazilian men and women aged 40 years or older. The prevalence of fragility fractures is about 15.1% in the women and 12.8% in the men. Moreover, advanced age, sedentarism, family history of hip fracture, current smoking, recurrent falls, diabetes mellitus and poor quality of life are the main clinical risk factors associated with fragility fractures. Introduction The Brazilian Osteoporosis Study (BRAZOS) is the first epidemiological study carried out in a representative sample of Brazilian men and women aged 40 years or older with the purpose of identifying the prevalence and the main clinical risk factors (CRF) associated with osteoporotic fracture in our population. Methods A total of 2,420 individuals (women, 70%) from 150 different cities in the five geographic regions in Brazil, and all different socio-economical classes were selected to participate in the present survey. Anthropometrical data as well as life habits, fracture history, food intake, physical activity, falls and quality of life were determined by individual quantitative interviews. The representative sampling was based on Brazilian National data provided by the 2000 and 2003 census. Low trauma fracture was defined as that resulting of a fall from standing height or less in individuals 50 years or older at specific skeletal sites: forearm, femur, ribs, vertebra and humerus. Sampling error was 2.2% with 95% confidence intervals. Logistic regression analysis models were designed having the fragility fracture as the dependent variable and all other parameters as the independent variable. Significance level was set as p<0.05. Results The average of age, height and weight for men and women were 58.4±12.8 and 60.1±13.7 years, 1.67±0.08 and 1.56±0.07 m and 73.3±14.7 and 64.7±13.7 kg, respectively. About 15.1% of the women and 12.8% of the men reported fragility fractures. In the women, the main CRF associated with fractures were advanced age (OR= 1.6; 95% CI 1.06-2.4), family history of hip fracture (OR= 1.7; 95% CI 1.1-2.8), early menopause (OR=1.7; 95% CI 1.02-2.9), sedentary lifestyle (OR=1.6; 95% CI 1.02-2.7), poor quality of life (OR=1.9; 95% CI 1.2-2.9), higher intake of phosphorus (OR=1.9; 95% CI 1.2-2.9), diabetes mellitus (OR=2.8; 95% CI 1.01-8.2), use of benzodiazepine drugs (OR=2.0; 95% CI 1.1-3.6) and recurrent falls (OR=2.4; 95% CI 1.2-5.0). In the men, the main CRF were poor quality of life (OR=3.2; 95% CI 1.7-6.1), current smoking (OR=3.5; 95% CI 1.28-9.77), diabetes mellitus (OR=4.2; 95% CI 1.27-13.7) and sedentary lifestyle (OR= 6.3; 95% CI 1.1-36.1). Conclusion Our findings suggest that CRF may contribute as an important tool to identify men and women with higher risk of osteoporotic fractures and that interventions aiming Osteoporos Int (at specific risk factors (quit smoking, regular physical activity, prevention of falls) may help to manage patients to reduce their risk of fracture.
Osteoporosis is a musculoskeletal disease characterized by decreased bone mineral density (BMD) and increased risk of fragility fractures. Osteoporosis is a silent disease with no symptoms until a fracture occurs. While osteoporosis has been traditionally considered a female disease, it is becoming an increasingly important male health problem, result in significant mortality and morbidity in men and lead to considerable societal costs, including direct medical costs and indirect costs resulting from reduced quality of life, disability, and death (Becker DJ 2010). It is estimated that the lifetime risk of experiencing an osteoporotic fracture in men over the age of 50 (in Sweden) is 30%, which is similar to the risk of developing prostate cancer (Merrill RM 1997). In the same line, osteoporotic fractures in men account for more hospital bed days than those due to prostate cancer (Kanis JA 2004). Moreover, one in three fragility fractures after the age of 50 years occurring in men (Johnell o 2006). Although at least 15-30% of men (Randell A 1995) will sustain one or more fragility fractures in their lifetime, the consequences of osteoporosis are underestimated, and the condition is often unrecognized and untreated in most men (Curtis JR 2009).
Revista De Saude Publica, 2010
Risk factors for osteoporotic fractures and low bone density in pre and postmenopausal women Fatores de risco para fratura por osteoporose e baixa densidade óssea em mulheres na pré e pós-menopausa ABSTRACT OBJECTIVE: To estimate the prevalence and analyze risk factors associated to osteoporosis and low-trauma fracture in women. METHODS: Cross-sectional study including a total of 4,332 women older than 40 attending primary care services in the Greater São Paulo, Southeastern Brazil, between 2004 and 2007. Anthropometrical and gynecological data and information about lifestyle habits, previous fracture, medical history, food intake and physical activity were obtained through individual quantitative interviews. Low-trauma fracture was defi ned as that resulting from a fall from standing height or less in individuals 50 years or older. Multiple logistic regression models were designed having osteoporotic fracture and bone mineral density (BMD) as the dependent variables and all other parameters as the independent ones. The signifi cance level was set at p<0.05. RESULTS: The prevalence of osteoporosis and osteoporotic fractures was 33% and 11.5%, respectively. The main risk factors associated with low bone mass were age (OR=1.
Management of Osteoporosis in Men: A Narrative Review
International Journal of Molecular Sciences
Male osteoporosis is a still largely underdiagnosed pathological condition. As a consequence, bone fragility in men remains undertreated mainly due to the low screening frequency and to controversies in the bone mineral density (BMD) testing standards. Up to the 40% of overall osteoporotic fractures affect men, in spite of the fact that women have a significant higher prevalence of osteoporosis. In addition, in males, hip fractures are associated with increased morbidity and mortality as compared to women. Importantly, male fractures occur about 10 years later in life than women, and, therefore, due to the advanced age, men may have more comorbidities and, consequently, their mortality is about twice the rate in women. Gender differences, which begin during puberty, lead to wider bones in males as compared with females. In men, follicle-stimulating hormones, testosterone, estrogens, and sex hormone-binding levels, together with genetic factors, interact in determining the peak of bo...
The epidemiology and management of postmenopausal osteoporosis: a viewpoint from Brazil
Clinical Interventions in Aging, 2015
Brazil has an aging population, with an associated increase in the prevalence of chronic diseases. Postmenopausal osteoporosis is of particular concern because it leads to an increased risk of fractures, with subsequent negative impacts on health in older women. In recent years, efforts have been made to better understand the epidemiology of osteoporosis in Brazil, and to manage both direct and indirect costs to the Brazilian health care system. The reported prevalence of osteoporosis among postmenopausal women in Brazil varies from 15% to 33%, depending on the study methodology and the use of bone densitometry data or self-reporting by participants. A diagnosis of osteoporosis can be made on the basis of fractures occurring without significant trauma or on the basis of low bone mineral density measured by dual energy X-ray absorptiometry. To reduce the risk of osteoporosis, all postmenopausal women should be encouraged to maintain a healthy lifestyle, which includes physical activity and a balanced diet. Smoking and alcohol use should also be addressed. Special attention should be given to interventions to reduce the risk of falls, especially among older women. Calcium intake should be encouraged, preferably through diet. The decision to recommend calcium supplementation should be made individually because there is concern about a possible increased risk of cardiovascular disease associated with this treatment. Brazilian women obtain a minimal amount of vitamin D from their diet, and supplementation is warranted in women with little exposure to solar ultraviolet-B radiation. For women diagnosed with osteoporosis, some form of pharmacologic therapy should be initiated. Compliance with treatment should be monitored, and the treatment period should be individualized for each patient. The Brazilian government provides medication for osteoporosis through the public health system free of charge, but without proper epidemiological knowledge, the implementation of public health programs is impaired.