The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Severe Osteoporosis in Men

Nicky Kelepouris, MD; Kristine D. Harper, MD; Francis Gannon, MD; Frederick S. Kaplan, MD; and John G. Haddad, MD
[+] Article, Author, and Disclosure Information

From the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania. Acknowledgments: The authors miss Drs. Maurice F. Attie and Michael Fallon, who died during completion of these studies, and thank Ms. Cordelia Shute and our general clinical research center staff for their help in conducting these studies and J. Simms for secretarial assistance. Grant Support: Supported in part by grants MO1-RR00040, RO1 AM28292, AM32760, and T32-AR07481 from the National Institutes of Health and by the Hartford Foundation Fellowship on Aging. Requests for Reprints: John G. Haddad, MD, Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania School of Medicine, 611 Clinical Research Building, 415 Curie Boulevard, Philadelphia, PA 19104-6149. Current Author Addresses: Dr. Kelepouris: Mercy-Fitzgerald Medical Office Building, Suite 206, 1501 Lansdowne Avenue, Darby, PA 19023.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(6):452-460. doi:10.7326/0003-4819-123-6-199509150-00010
Text Size: A A A

Objective: To evaluate men with severe osteoporosis for pathogenetic factors and to review the reported features of primary osteoporosis in men.

Design: Case series and clinical review.

Patients: 47 men consecutively referred to a metabolic bone center because of atraumatic (or minimally traumatic) fractures (91%) or radiographic osteopenia (9%).

Measurements: Clinical assessment, radiographs, chemical analyses of serum and urine, hormone assays, skeletal densitometry, and histomorphometry of iliac crest biopsy specimens.

Results: 27 of the 47 men (57%) had vertebral fractures, and 16 (34%) had appendicular fractures. Causal factors identified in 30 men (64%) included glucocorticosteroid treatment (8 men); hypogonadism (7 men); excessive alcohol consumption (7 men); and anticonvulsant use, osteomalacia, severe hyperthyroidism, or bone marrow neoplasia (8 men). Seventeen men (36%) had no medical conditions or known risk factors associated with bone disease. Spinal mineral density was well below the mean value for healthy young men in 94% of the patients with primary osteoporosis tested. Examination of biopsy specimens from 13 of 17 men with primary osteoporosis showed reduced trabecular bone volumes, normal bone formation rates, and slightly increased resorption surfaces. Fasting hypercalciuria was seen in some men (41%). In the primary osteoporosis group, eight men were followed serially (range of follow-up, 6 months to 9 years) while they were receiving a nonpharmacologic regimen (diet and activity); the mean axial bone mineral density of these men increased slightly.

Conclusions: A thorough evaluation for identifiable causes of severe osteoporosis in men is warranted because definable pathogenetic factors are seen in many cases. A few men with severe osteoporosis have primary or idiopathic osteoporosis. Primary osteoporosis in men is probably caused by many factors because heterogeneous clinical, laboratory, and histologic features were seen in our series and in those of others. Further studies of primary osteoporosis are needed to define the course of the disease, to identify pathogenetic mechanisms, and to develop therapeutic interventions.







Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.