December 2, 2010
Routine laboratory testing may reveal underlying causes of osteoporosis in men whose bone loss was initially thought to have no known cause, according to a study in the October Osteoporosis International.
The study of osteoporosis in men found that the overwhelming majority of subjects' osteoporosis was caused by low testosterone levels, vitamin D deficiency, the body's inability to absorb calcium, mildly underactive thyroid, or overactive thyroid.
Although it is more common in women, osteoporosis poses a significant threat to more than 2 million men in the United States. One in four men over age 50 will have an osteoporosis-related fracture in their remaining lifetime, according to the National Institutes of Health (NIH). There are two types of the disease: primary osteoporosis is age-related bone loss, while secondary osteoporosis is caused by lifestyle factors, some medical conditions, and use of certain drugs.
To investigate causes of osteoporosis in men, the researchers reviewed the charts of 234 men (mean age 70.6 years) previously diagnosed with osteoporosis. The men had been evaluated for osteoporosis using bone mineral density (BMD) testing by dual energy X-ray absorptiometry (Dexa scan) to measure bone density in hips and spines. Testing also included basic serum chemistries,25-hydroxyvitamin D, testosterone, luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, and spot urinary calcium-to-creatinine ratio.
At the beginning of the study, 45% of the men were thought to have primary osteoporosis, and 55% had at least one specific secondary cause of osteoporosis such as use of glucocorticosteroids, inadequate functioning of the sex glands (hypogonadism), or chronic kidney failure. Laboratory testing revealed secondary osteoporosis in a majority of the men studied overall (about 75%). Causes included low testosterone levels (24%), vitamin D deficiency (20%), and to lesser extents, inability to absorb calcium, sluggish thyroid, and mildly overactive thyroid.
Even in men known to have secondary osteoporosis at the time of referral to the study, the researchers found 52% to have additional causes of secondary osteoporosis upon laboratory investigation.
Osteoporosis can be effectively treated if it is detected before significant bone loss has occurred. A medical workup to diagnose osteoporosis may include a complete medical history, x-rays, urine and blood tests, and a bone mineral density test (BMD). This test can identify osteoporosis, determine fracture risk, and measure response to treatment.
It is increasingly common for women to be diagnosed with osteoporosis or low bone mass using a BMD test, often at midlife when doctors begin to watch for signs of bone loss. In men, however, testing and diagnosis often doesn't take place until after a fracture occurs or a man complains of back pain.
Once a man is diagnosed with osteoporosis, he should receive a complete blood count and tests forcalcium, phosphorus, creatinine and vitamin D levels in the blood, and calcium in urine, the researchers suggest. Tests for testosterone level and thyroid function might also be helpful. In a few cases, specific tests for multiple myeloma or celiac disease may be necessary, they add.
Men are often unaware of how healthy habits can help them avoid osteoporosis. These include not smoking, reducing alcohol intake, and increasing physical activity. Getting enough calcium and vitamin D are also important, according to NIH. It also suggests men discuss with their doctors use of medications that are known to cause bone loss, such as glucocorticoids, which are often prescribed to transplant patients and those with autoimmune diseases.
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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.
Ryan C, Petkov V, Adler R. Osteoporosis in Men: The value of laboratory testing. Osteoporos Int DOI 10.1007/s00198-010-1421-0. Available onlin at: http://www.springerlink.com/content/t511307167178676/fulltext.html throughhttp://www.springerlink.com. Accessed November 2010.
Fact sheet. Osteoporosis in Men. NIH Osteoporosis and Related Diseases National Resource Center. Available online at http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/men.asp throughhttp://www.niams.nih.gov. Reviewed June 2010. Accessed November 23, 2010.
Laura Dean. Simple Laboratory Tests Identify Secondary Osteoporosis In Men. Medwire News. Available online at http://www.medwire-news.md/437/89724/Bone_Health/Simple_laboratory_tests_identify_secondary_osteoporosis_in_men.html through http://www.medwire-news.md. Published October 20, 2010. Accessed November 23, 2010.
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