Article

Bone Health in Men: Influencing Factors

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Abstract

To describe osteoporosis health beliefs, osteoporosis risk factors, and lifestyle habits that affect bone health in men. Data were collected from 272 men using the Bone Health in Men questionnaire. The majority of participants reported that they were unlikely to develop osteoporosis, that osteoporosis in men is less serious than in women, and that osteoporosis is preventable. Few osteoporosis risk factors were reported. The lifestyle habits reported were below the suggested recommendations. Increasing men's awareness of osteoporosis risk factors, changing their beliefs, and encouraging them to adopt healthy lifestyle habits are necessary strategies to promote bone health.

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... Osteopenia and osteoporosis are major contributors to the increased incidences of fractures seen in post-menopausal women and some older men (Bareither et al., 2008). The effect of osteoporosis also varies between genders (Ali et al., 2009). ...
... Bone metabolism has different affects on men and women (Ali et al., 2009). Males tend to have larger bones when compared to females and they tend to have higher peaks of bone mass and greater cortical mass (Ali et al., 2009;Avdagic et al., 2009;Orwoll et al., 2001). ...
... Bone metabolism has different affects on men and women (Ali et al., 2009). Males tend to have larger bones when compared to females and they tend to have higher peaks of bone mass and greater cortical mass (Ali et al., 2009;Avdagic et al., 2009;Orwoll et al., 2001). The gender differences in peak bone mass attainment are well recognized and may account for a substantial portion of the increased incidence of fragility fractures in women compared to men (Orwoll et al., 2001). ...
... Nine articles were identified that studied knowledge of OP in men [53][54][55][56][57][58][59][60][61]. All studies were descriptive, cross-sectional by design. ...
... Chevalley et al. [15] N = 385; men = 74; sample consisted of patients with fractures; evaluated OP clinical pathway including a 12 week OP education program; 73% believed fracture not related to OP; 86% had low bone mass or OP; at 6-month follow-up, calcium and vitamin D was being taken by 86% of the evaluated patients and 67% were taking prescribed osteoporotic medications Davis et al. [16] N = 47; men = 7; intervention consisted of six 1-h educational session; at the 6-month follow-up, OP knowledge was increased over baseline Fraser [17] No sample size provided; describes the development of a fracture liaison service to locate, assess and educate patients; no scores given Solomon et al. [23] N = 636; men = 10; mailed OP education intervention; knowledge test mean score was 65% correct but no significant difference between the control and intervention groups; note: this study over-sampled men in the randomization process Solomon et al. [24] N = 828 primary care providers and 13,455 patients; OP education intervention trial with four arms: PCP education alone; patient education alone; PCP and patient education; control; no significant difference found between groups in rates of post-education BMD testing or initiation of osteoporotic medication Yoon et al. [25] N = 139; men = 31; sample consisted of patients post-fragility fracture; intervention consisted on a 30-min education session with a 10-min follow-up session; outcome was BMD testing-6% of the men received BMD testing Yuksel et al. [26] N = 262; men = 93; intervention combined quantitative ultrasound for bone quality with OP education; outcome measures were BMD testing within 4 months and initiation of osteoporotic medication; reported greater percentages of BMD testing and supplemental calcium initiation in the education group than the control group; no effect on knowledge was found second study reported on 242 older men randomly selected from all men living at a retirement community [56]. Five of the studies use a convenience sample composed only of men [53,54,57,59,61]. ...
... Four researchers designed or adapted their own OP knowledge test [53,54,58,60]. Two studies reported adequate validity and reliability for the developed tool [53,54]. ...
Article
The prevalence of osteoporosis and low bone density in men over the age of 65 is approximately 45%. The public health response to a disease affecting almost half of a given population includes assessment of knowledge and design of educational interventions in order to improve screening and prevention. The aim of this systematic review is two fold. We aim to describe older men's knowledge about the osteoporosis disease process, risk factors, and prevention. Second, we examine educational interventions designed to increase older men's knowledge about osteoporosis. Computerized literature searches were performed with multiple databases including Academic Search Premier, CINAHL, MEDLINE, SocINDEX, and Psychology and Behavioral Sciences Collection. Studies were considered if they included men aged 50 years or older, included a measure of osteoporosis knowledge and/or had an intervention designed to change osteoporosis knowledge and/or lifestyle risk factors for osteoporosis. Thirteen studies were included in the review. Nine of the studies were cross-sectional studies on men's knowledge of osteoporosis. All of the studies found that men have minimal knowledge of the osteoporosis disease process, risk factors, and prevention. Four studies focused on education about osteoporosis. Educational interventions were found to increase initiation of calcium supplementation and knowledge about osteoporosis prevention. Older men know remarkably little about the osteoporosis disease process, risk factors for the disease, or prevention. Education has the potential to improve this situation. Unfortunately, so few clinical trials have occurred that the best method for improving men's knowledge cannot be stated. Future studies examining knowledge and education of osteoporosis for men need to use validated instruments with a focus on risk factors pertinent to men.
... Explanations for the sex difference in osteoporosis outcomes include sex-based differences in access to bone densitometry evaluation (i.e., dual-energy X-ray absorptiometry (DXA)) [8,9]; the social construction of osteoporosis as a "women's" disease and the effect of this gendering on men's perceived susceptibility [10,11]; lack of consensus among professional clinical societies as to effective criteria for osteoporosis evaluation in men [12]; professional uncertainty regarding clinical ownership of diagnosis and treatment [12]; the competition of comorbidities for individual patient and provider attention; provider's lack of confidence in the efficacy of existing interventions to improve osteoporosis outcomes in men; patient's fear of rare side effects associated with some bisphosphonates [12,13]; and poor patient and provider knowledge about osteoporosis risk factors [13,14]. ...
... Our findings demonstrate that OSE can be administered to both men and women and that factors predicting exercise and calcium self-efficacy differed by sex. Given that men report significantly higher osteoporosis-related mortality and lower osteoporosis-related quality of life than women [10,33], it is important to consider the potential contribution of sex differences in self-efficacy regarding preventive behaviors of exercise and consumption of dietary calcium and vitamin D. At the same time, clinicians should be cognizant that differences in gender socialization may compel men to actively engage in behaviors that counteract their health interests [34]. Thus, while men may report competence in adopting and performing health behaviors, this competency may not translate into preventive health behavior [35]. ...
Article
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The Osteoporosis Self Efficacy Scale was determined to equivalently measure calcium and exercise beliefs in both sexes. Despite data illustrating men’s and women’s similar self-efficacy, gender differences in clinical predictors of self-efficacy imply that efforts to improve care must account for more than self-efficacy. Introduction To understand the extent to which the Osteoporosis Self Efficacy (OSE) Scale is reliable for both men and women. A secondary objective was to evaluate sex differences in OSE. Methods For this cross-sectional study, we analyzed data collected as part of the Patient Activation after DXA Result Notification (PAADRN) pragmatic trial which enrolled 7749 community-residing adults aged 50 and older reporting for bone densitometry. We used univariable methods, item analysis, exploratory and confirmatory factor analyses, and linear regression to evaluate sex differences in OSE responses and measurement. Results In this sample, the confirmatory factor analysis model for OSE both overall and within groups indicated a poor fit. The sex differences in the measurement model, however, were minor and reflected configural invariance (i.e., constructs were measuring the same things in both men and women), confirming that the OSE was measuring the same constructs in men and women. Men overall had higher exercise self-efficacy and women higher calcium self-efficacy. Overall, education, hip fracture, and self-reported health status predicted exercise self-efficacy whereas prior DXA, self-reported osteoporosis, and history of pharmacotherapy use did not. Predictors of calcium self-efficacy differed by gender. Conclusion The OSE can be used to measure calcium and exercise self-efficacy in all older adults. However, gender differences in clinical predictors of self-efficacy and the lack of an association of prior DXA with self-efficacy imply that interventions to improve self-efficacy may be insufficient to drive significant improvement in rates of osteoporosis evaluation and treatment. Trial registration Patient Activation after DXA Result Notification (PAADRN), NCT01507662, https://clinicaltrials.gov/ct2/show/NCT01507662
... In this review, we explore the following research questions: (1) What are the sex-based differences in bone biology, bone morphometry, osteoporosis pathophysiology, and fracture healing that may influence morbidity and mortality in patients with osteoporosis? (2) What are the gender-based differences in screening and primary prevention for osteoporosis? (3) What are the gender-based differences in medication response and adherence to treatment recommendations for osteoporosis? ...
... Unfortunately, efforts for preventing future fractures are also failing; men believe osteoporosis is a more serious disease for women and they are less likely to develop osteoporosis [2]. These misconceptions are coupled with a lack of physician awareness [22] and a lack of consensus regarding screening guidelines. ...
Article
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Background Osteoporosis remains underrecognized and undertreated in both men and women, but men who sustain fragility fractures experience greater morbidity and mortality. While men exhibit advanced comorbidity at the time of hip fracture presentation, there are distinct sex- and gender-specific factors related to the pathophysiology and treatment of osteoporosis that further influence morbidity and mortality. Questions/purposes With a selective review of the literature, we evaluated sex- and gender-based differences contributing to increased morbidity and mortality in men with osteoporosis. Where are we now? Sex-specific differences in bone biology and morphology may affect the pathophysiology of osteoporosis, choice of pharmacotherapy, and surgical implant selection. Additionally, estrogen metabolism may play a key role in both fracture prevention and healing. Gender-based differences in recommendations for screening and prevention between men and women may influence the severity at which osteoporosis is recognized. Primary, secondary, and tertiary prevention efforts in men lag behind those of women. This may be due to a lack of consensus regarding screening guidelines for osteoporosis in men but may be attributed to lack of awareness in the physician and patient about osteoporosis and its potentially debilitating consequences. Where do we need to go? These disparities are a call to action for healthcare providers to raise awareness for early prevention and treatment of this potentially debilitating disease, particularly in men. How do we get there? Continued prospective research on the differences between men and women diagnosed with osteoporosis is needed, as well as sex-specific stratification of data in all studies on osteoporosis.
... Bisphosphonates were developed when women were essentially the exclusive recipients of osteoporosis diagnoses and treatments [73]. Misunderstandings of the risk of osteoporosis in men remain problematic among both patients and clinicians [74], and osteoporosis remains more underdiagnosed and undertreated in men than women [68,75,76]. ...
Article
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Bisphosphonates are first-line therapy for osteoporosis, with alendronate, risedronate, and zoledronate as the main treatments used globally. After one year of therapy, bisphosphonates are retained in bone for extended periods with extended anti-fracture effects after discontinuation. Due to this continued fracture protection and the potential for rare adverse events associated with long-term use (atypical femoral fractures and osteonecrosis of the jaw), a drug holiday of two to three years is recommended for most patients after long-term bisphosphonate therapy. The recommendation for a drug holiday up to three years is derived primarily from extensions of pivotal trials with alendronate and zoledronate and select surrogate marker studies. However, certain factors may modify the duration of bisphosphonate effects on a drug holiday and warrant consideration when determining an appropriate time off-therapy. In this narrative review, we recall what is currently known about drug holidays and discuss what we believe to be the primary considerations and areas for future research regarding drug holiday duration: total bisphosphonate exposure, type of bisphosphonate used, bone mineral density and falls risk, and patient sex and body weight.
... At present, the development of osteoporosis is considered to be associated with factors such as endocrine levels, genes, nutrition, vitamins, and lifestyle [23][24][25][26][27][28][29]. However, the specific causes of osteoporosis are not yet completely understood. ...
Article
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Diabetic patients have an increased risk of osteoporosis-associated fractures. However, the results of most studies of the effects of diabetes on bone mass in patients with type 2 diabetes (T 2 DM) have been contradictory. To clarify these conflicting findings, we investigated the effects of diabetic serum on the proliferation and osteogenic differentiation of mesenchymal stem cells (MSCs). We used human sera from subjects with different levels of glycemic control to culture the MSCs and induce osteogenic differentiation. The rate of MSC proliferation differed when MSCs were cultured with sera from diabetic subjects with different levels of hyperglycemia. Hyperglycemic sera promoted MSC proliferation to some extent, but all the diabetic sera inhibited the differentiation of MSCs to osteoblasts. The effects of type 2 diabetic sera on the proliferation and osteogenic differentiation of MSCs are closely related to glycemic control. Our data demonstrate the importance of stratifying the study population according to glycemic control in clinical research into diabetic osteoporosis.
... The risk of fracture for men on ADT is twice that of healthy controls or men with prostate cancer who are not on ADT [16] with rates as high as 20 % after 5 years of treatment [12,17]. Fractures secondary to OP cause severe pain, fatigue, functional impairment, chronic disability, and increased mortality [11,[18][19][20]. They also present a significant cost to the health care system [21,22]. ...
Article
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Men receiving androgen deprivation therapy for prostate cancer have low knowledge of osteoporosis (OP) and engage in few healthy bone behaviors (HBBs). A multicomponent intervention was piloted in this population. Changes in OP knowledge, self-efficacy, health beliefs, and engagement in HBBs were evaluated. A pre-post pilot study was performed in a convenience sample of men recruited from the Princess Margaret Cancer Centre. Men were sent personalized letters explaining their dual x-ray absorptiometry (DXA) results and fracture risk assessment with an OP-related education booklet. Participants completed questionnaires assessing OP knowledge, self-efficacy, health beliefs, and current engagement in HBBs at baseline (T1) and 3 months post-intervention (T2). Paired t tests and McNemar's test were used to assess changes in outcomes. A total of 148 men completed the study. There was an increase in OP knowledge (9.7 ± 4.3 to 11.4 ± 3.3, p < 0.0001) and feelings of susceptibility (16.5 ± 4.3 to 17.4 ± 4.7, p = 0.015), but a decrease in total self-efficacy (86.3 ± 22.9 to 81.0 ± 27.6, p = 0.007) from baseline to post-intervention. Men made appropriate changes in their overall daily calcium intake (p ≤ 0.001), and there was uptake of vitamin D supplementation from 44 % (n = 65) to 68 % (n = 99) (p < 0.0001). Men with bone loss (osteopenia or OP) had a greater change in susceptibility (1.9 ± 4.3 vs. -0.22 ± 4.2, p = 0.005) compared to men with normal bone density. Our results provide preliminary evidence that a multicomponent intervention such as the one described can lead to increased knowledge and feelings of susceptibility regarding OP and can enhance uptake of some HBBs.
... An individual's bone mass reaches the peak usually around age 30 years and declines thereafter. Of the limited studies on men's knowledge of osteoporosis, very few recruited younger subjects or the age distribution of the sample was not specified (Ali, Shonk, & El-Sayed, 2009;Tung & Lee, 2006). Risk factors of osteoporosis could have been present but neglected for decades before fractures occur. ...
Article
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Male osteoporosis is underappreciated. Little is known about men's knowledge of osteoporosis and how much men are at risk. This study surveyed men's knowledge of osteoporosis and their risk factors with reference to women in the primary care setting in Macau, China. A convenience sample of 302 men and 635 women aged 18 to 90 years completed questionnaires comprising the Osteoporosis Knowledge Assessment Tool and the One-Minute Osteoporosis Risk Test. Their risks of osteoporosis were assessed with the Osteoporosis Self-Assessment Screening Test. Men and women, who were aged 55 years or below, had similarly limited knowledge of osteoporosis. People aged above 55 years had significantly less knowledge; men had less knowledge than women only in this age-group. If questions specific to women or menopause were excluded, men had similar knowledge as women. A higher proportion of men than women had risk factors as more men consumed alcohol or smoked tobacco. Similar proportions of men and women reported a loss of 1 inch in body height after age 40. After age 55, 29.2% men were at medium to high risk of osteoporosis. This study concludes that health education and primary prevention of osteoporosis should be promoted to men starting in middle-age.
... Despite the high risk for accelerated bone loss, the consequences of fractures, and the existence of guidelines, preliminary data suggests that a minority (18%) of men on ADT in Ontario have a DXA test done Յ2 years of starting ADT [36] and that most men on ADT do not routinely receive information, evaluation, or treatment for bone loss [13, [37][38][39][40]. Research to date suggests that men in the general population are less aware and knowledgeable about OP and related preventive behaviours and feel less susceptible to OP than women [35,41]. One study found that up to half of men on ADT are unaware of its significant potential side-effects including OP and increased fracture risk [42], and preliminary data suggest that most do not have adequate calcium and vitamin D intake [37]. ...
Article
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Objectives: To describe in patients with prostate cancer, receiving androgen-deprivation therapy (ADT): (i) knowledge, self-efficacy (SE), and health beliefs about osteoporosis (OP); (ii) current engagement in healthy bone behaviours (HBBs). To explore the relationships between knowledge, SE, and health beliefs, and engagement in HBBs. Patients and methods: 175 patients receiving ADT by injection completed questionnaires assessing current HBBs, OP knowledge, SE, and health beliefs (motivation, perceived susceptibility, and seriousness). Descriptive statistics and independent samples t-tests were used to assess relationships between knowledge, SE, health beliefs, and engagement in HBBs. Results: Only 38% of patients had undergone a dual X-ray absorptiometry scan in the past 2 years. OP knowledge was low (mean [sd, range] 9.6 [4.4, 0-19]) and perceived SE moderate (84.7 [24.5, 0-120]). Health motivation was fairly high (23.6 [3.1, 6-30]), but perceived susceptibility (16.8 [4.3]) and seriousness (16.8 [4.2]) of OP were low. Few patients met the recommendations for vitamin D intake (42%) and exercise (31%), and 15% were at risk of over-supplementation of calcium. Patients taking calcium supplements (P = 0.04), and meeting guidelines for vitamin D (P = 0.008) and for exercise (P = 0.002) had significantly greater knowledge than those who did not. Patients who were engaging in less than four of five HBBs had lower knowledge (P < 0.001) and health motivation (P = 0.01) than those who were engaging in four or all five HBBs. Conclusions: Most patients who are receiving ADT are not receiving appropriate screening, lack basic information about bone health, and are not engaging in the appropriate HBBs. These findings support the application of the Health Belief Model in this population: interventions that teach patients about the implications of bone loss, encourage proper uptake of HBBs, and promote feelings of SE could increase engagement in HBBs to prevent and manage bone loss.
... Some of this sex difference may derive from men's underdiagnosis and under- treatment [9, 10]. Men report less susceptibility to OP than do women [11, 12], and healthcare providers may not be familiar with prevention guidelines. For example, in a study of gluccocorticoid-induced OP, many providers were not familiar with the need for BMD monitoring or recommendations for calcium or bisphosphonate use [13]. ...
Article
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The Male Osteoporosis Assessment Questionnaire (OPAQ™) is a health-related quality of life (HRQOL) instrument that can differentiate between men with and without fracture. The Male OPAQ™ is a reliable and validated instrument that may be utilized in clinical trials seeking to include male populations. Men with osteoporosis (OP) experience poorer clinical outcomes than do women with the disorder, but little is known about the impact of OP on men's HRQOL. This study aimed to test the validity, reliability, and ability to differentiate between men with and without fracture of an HRQOL for men with osteoporosis, the Male OPAQ™. The OPAQ and OPAQ-SV were tested for face validity in interviews with male OP patients, and a revised, male-specific instrument was developed. Thirty-seven men ages 50+ completed the Male OPAQ™ and SF-12 at baseline and a two-week retest of the Male OPAQ™. To analyze both the domain and dimension scores, a normalization procedure was performed on the data to determine health status scores from 0 to 100. Descriptive statistics were calculated for each item and site. Reliability and validity of the Male OPAQ™ were assessed using Pearson's r. The Male OPAQ™ can discriminate between men with and without fracture, and men who have more fractures have poorer scores. Instrument domains correspond to those of the SF-12. The Male OPAQ(TM) is a brief and sensitive tool for measuring HRQOL in men with OP. Further testing in a more diverse and large sample is warranted.
Article
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Background: Osteoporosis is one of the most under-diagnosed and under-treated health conditions in Canada. This study questioned whether an invitation to self-refer for osteoporosis risk evaluation would improve the number of patients who were tested for bone mineral density (BMD) at a rural Primary Health Care Center (PHCC). Purpose: The purpose of this study is to improve osteoporosis care and decrease bone fracture risk in a population of patients 65 years of age and older. Methodology: A quasi-experimental research design was used to review screening rates of BMD testing and identified patients in this population who were at low, moderate, and high risk for developing osteoporosis. Screening rates at the PHCC were compared to screening rates at another rural PHCC in the province. Conclusion: The self-referral program for BMD testing and a nurse-led intervention resulted in an increased number of people who were BMD tested at the study PHCC compared with the control PHCC, and identified more male patients 65 years of age and older who were at risk for osteoporosis and bone fractures. Recommendations suggest future research in other provincial PHCCs that may encourage self-referral programs for BMD testing and improved osteoporosis care for patients 65 years of age and older.
Article
Objective: To examine the role of socioeconomic variables on middle-aged adult men's knowledge and health beliefs about osteoporosis. Methods: An anonymous survey used validated scales to assess osteoporosis knowledge and health beliefs in a sample of 262 men aged 36-55 years. Descriptive and group-differences statistics (MANOVA and ANOVA) were used. Results: Total osteoporosis knowledge was low (mean, 11.1 of 22) and mean scores on perceived susceptibility and seriousness health belief domains were also low: 13.2 and 17.2, respectively out of 30. Multivariate ANOVA revealed that perceived seriousness, barriers to calcium intake, and health motivation varied significantly with level of formal education attained (P < .05). There was no significant difference with income. Conclusions and implications: Results of this convenience sample of predominantly white men found that level of osteoporosis knowledge and perceived susceptibility were low. Given the increased prevalence of osteoporosis-related fracture in men, methods to increase knowledge and awareness are needed.
Article
In our qualitative study, men with fragility fractures described their spouses as playing an integral role in their health behaviours. Men also described taking risks, preferring not to dwell on the meaning of the fracture and/or their bone health. Communication strategies specific to men about bone health should be developed. Introduction We examined men’s experiences and behaviours regarding bone health after a fragility fracture. Methods We conducted a secondary analysis of five qualitative studies. In each primary study, male and female participants were interviewed for 1–2 h and asked to describe recommendations they had received for bone health and what they were doing about those recommendations. Maintaining the phenomenological approach of the primary studies, the transcripts of all male participants were re-analyzed to highlight experiences and behaviours particular to men. Results Twenty-two men (50–88 years old) were identified. Sixteen lived with a wife, male partner, or family member and the remaining participants lived alone. Participants had sustained hip fractures (n = 7), wrist fractures (n = 5), vertebral fractures (n = 2) and fractures at other locations (n = 8). Fourteen were taking antiresorptive medication at the time of the interview. In general, men with a wife/female partner described these women as playing an integral role in their health behaviours, such as removing tripping hazards and organizing their medication regimen. While participants described giving up activities due to their bone health, they also described taking risks such as drinking too much alcohol and climbing ladders or deliberately refusing to adhere to bone health recommendations. Finally, men did not dwell on the meaning of the fracture and/or their bone health. Conclusions Behaviours consistent with those shown in other studies on men were described by our sample. We recommend that future research address these findings in more detail so that communication strategies specific to men about bone health be developed.
Article
While data on the effects of aging on bone loss in women are well known, many healthcare providers and patients are less familiar with the prevalence and impact of bone changes in older males. Understanding expected bone health changes and factors that predict accelerated bone loss is essential to designing preventive health maintenance strategies for men and women. This chapter reviews the epidemiology of bone loss with aging in men, including definitions of abnormal bone density and other methods for assessing bone changes with aging. Factors affecting bone loss in men, including ethnic factors, weight and vitamin intake, are also reviewed, as these may provide important markers when assessing male osteoporosis risk in the clinic. Practical approaches to maximize osteoporosis screening in men are also described.
Article
Purpose: We examined the relationship between the health-related issues of elderly women and bone density and identified specific factors that affect the prevalence of osteoporosis to provide basic data for developing a health care program on osteoporosis prevention. Methods: This study is a secondary data analysis of 118,903 66-yr-old women who received a health examination conducted by the National Health Insurance Corporation in 2008. Multiple logistic regression analysis was used to identify factors affecting the prevalence of osteoporosis. Results: The prevalence of osteoporosis was 46.8%, whereas the prevalence of osteopenia was 38.4% among elderly women in this study. Statistically significant differences were observed between the osteoporosis and non-osteoporosis group in terms of smoking (p
Article
BACKGROUND: There is clear evidence that men suffer from osteoporosis (OP) in increasing numbers, but that men commonly remain underdiagnosed, undertreated and experience poorer outcomes than do women. The widespread sociocultural association of OP with postmenopausal women reflects their greater risk for developing the disorder, but the sexing of OP as a women's disease disadvantages at-risk men. METHODS: This paper reports on qualitative data gathered from 23 community-residing men who have an OP diagnosis. RESULTS: Interviews with men reveal that the sexing of OP as a female disease may affect men's risk appraisal. Men clearly associate OP risk factors with women and accordingly may feel protected from the disorder. Subsequent to diagnosis, men's OP-related risk management strategies reveal that men's gender identity constrains their ability to enact risk-reducing behavior. CONCLUSIONS: Men may internalize the association of OP with women and incorporate it into a sense of perceived invulnerability to the condition, which, in turn, contributes to delayed diagnosis and treatment. Limited male-specific treatment and support options as well as social expectations of male gender performance play roles in men's health behavior.
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High intakes of alcohol have adverse effects on skeletal health, but evidence for the effects of moderate consumption are less secure. The aim of this study was to quantify this risk on an international basis and explore the relationship of this risk with age, sex, and bone mineral density (BMD). We studied 5,939 men and 11,032 women from three prospectively studied cohorts comprising CaMos, DOES, and the Rotterdam Study. Cohorts were followed for a total of 75,433 person-years. The effect of reported alcohol intake on the risk of any fracture, any osteoporotic fracture, and hip fracture alone was examined using a Poisson model for each sex from each cohort. Covariates examined included age and BMD. The results of the different studies were merged using weighted beta-coefficients. Alcohol intake was associated with a significant increase in osteoporotic and hip fracture risk, but the effect was nonlinear. No significant increase in risk was observed at intakes of 2 units or less daily. Above this threshold, alcohol intake was associated with an increased risk of any fracture (risk ratio [RR] = 1.23; 95% CI, 1.06-1.43), any osteoporotic fracture (RR = 1.38; 95% CI, 1.16-1.65), or hip fracture (RR = 1.68; 95% CI, 1.19-2.36). There was no significant interaction with age, BMD, or time since baseline assessment. Risk ratios were moderately but not significantly higher in men than in women, and there was no evidence for a different threshold for effect by gender. We conclude that reported intake of alcohol confers a risk of some importance beyond that explained by BMD. The validation of this risk factor on an international basis permits its use in case-finding strategies.
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Osteoporotic fractures are increasing among Asian populations in both genders, but the risk factors for low bone mineral density (BMD) in Asian men is unclear. To determine the hormonal and lifestyle risk factors for low BMD in Asian men, we studied 407 community-dwelling southern Chinese men aged 50 years and above. Medical history and lifestyle habits were obtained with a structured questionnaire. Dietary calcium and phytoestrogen intake were assessed by a semi-quantitative questionnaire. BMD at the spine and hip were measured by dual-energy X-ray absorptiometry (DXA). Fasting blood was analyzed for 25(OH)D, parathyroid hormone (PTH), total and bioavailable estradiol (bio-E) and testosterone (bio-T). The mean age of the cohort was 68.42+/-10.4 (50-96) years. In the linear regression model, weight, age, body mass index (BMI), bio-E, PTH, cigarette smoking and weight-bearing exercise were significant determinants of total hip BMD. Together they explained 55% of the total variance of hip BMD, with body weight being the most important determining factor. With age and weight adjustment, height, bio-T and flavonoid intake were identified as additional determinants of total hip BMD. Strategies to prevent bone loss and osteoporosis in Asian men should include lifestyle modification and maintenance of hormonal sufficiency.
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It remains uncertain whether long-term participation in regular weight-bearing exercise confers an advantage to bone structure and strength in old age. The aim of this study was to investigate the relationship between lifetime sport and leisure activity participation on bone material and structural properties at the axial and appendicular skeleton in older men (>50 years). We used dual-energy X-ray absorptiometry (DXA) to assess hip, spine and ultradistal (UD) radius areal bone mineral density (aBMD) (n=161), quantitative ultrasound (QUS) to measure heel bone quality (n=161), and quantitative computed tomography (QCT) to assess volumetric BMD, bone geometry and strength at the spine (L(1)-L(3)) and mid-femur (n=111). Current (>50+ years) and past hours of sport and leisure activity participation during adolescence (13-18 years) and adulthood (19-50 years) were assessed by questionnaire. This information was used to calculate the total time (min) spent participating in sport and leisure activities and an osteogenic index (OI) score for each participant, which provides a measure of participation in weight-bearing activities. Regression analysis revealed that a greater lifetime (13-50+ years) and mid-adulthood (19-50 years) OI, but not total time (min), was associated with a greater mid-femur total and cortical area, cortical bone mineral content (BMC), and the polar moment of inertia (I (p)) and heel VOS (p ranging from <0.05 to <0.01). These results were independent of age, height (or femoral length) and weight (or muscle cross-sectional area). Adolescent OI scores were not found to be significant predictors of bone structure or strength. Furthermore, no significant relationships were detected with areal or volumetric BMD at any site. Subjects were then categorized into either a high (H) or low/non-impact (L) group during adolescence (13-18 years) and adulthood (19-50+ years) according to their OI scores during each of these periods. Three groups were subsequently formed to reflect weight-bearing impact categories during adolescence and then adulthood: LL, HL and HH. Compared to the LL group, mid-femur total and cortical area, cortical BMC and I (p) were 6.5-14.2% higher in the HH group. No differences were detected between the LL and HL groups. In conclusion, these findings indicate that long-term regular participation in sport and leisure activities categorized according to an osteogenic index [but not the total time (min) spent participating in all sport and leisure activities] was an important determinant of bone size, quality and strength, but not BMD, at loaded sites in older men. Furthermore, continued participation in weight-bearing exercise in early to mid-adulthood appears to be important for reducing the risk of low bone strength in old age.
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Smoking has previously been associated with reduced areal bone mineral density (aBMD) in elderly subjects, but the association remains controversial in adolescents. The aim of this study was to determine whether smoking was associated with aBMD or volumetric BMD (vBMD) and bone size in young men. aBMD was measured using dual x-ray absorptiometry. vBMD and bone size were measured using peripheral quantitative computerized tomography (pQCT). Smoking habits were assessed using questionnaires. Levels of sex steroids, PTH, and 25-OH-vitamin D were measured in serum. The population-based Gothenburg Osteoporosis and Obesity Determinants (GOOD) study includes 1068 young men, age 18.9 +/- 0.6 yr (mean +/- SD). The main outcome measure was smoking as predictor of bone parameters and serum sex hormone levels. Of the study subjects, 8.7% smoked daily. Bone parameters were compared between smokers and nonsmokers. Smokers had significantly lower aBMD (dual x-ray absorptiometry) of the total body (crude: -2.1%; adjusted for age, height, weight, calcium intake, and physical activity: -1.8%), lumbar spine (crude: -4.3%; adjusted: -3.3%), and trochanter (crude: -6.6%; adjusted: -5.0%) than nonsmokers. Using peripheral quantitative computerized tomography, we found that smokers had lower cortical thickness of both the radius (crude: -2.8%; adjusted: -2.9%) and tibia (crude: -4.5%; adjusted: -4.0%) than the nonsmokers, whereas no difference was seen for cortical vBMD. Smokers had higher serum levels of total and free testosterone and lower 25-OH-vitamin D than nonsmokers. Adjustment for testosterone and/or 25-OH-vitamin D levels did not alter the associations between smoking and bone parameters. We demonstrate that smoking was associated with lower aBMD and reduced cortical thickness in young men.
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In 2002, Osteoporosis Canada published clinical practice guidelines for the diagnosis and management of osteoporosis. The current paper supplements that guideline and provides a review and synthesis of the current literature on the diagnosis and management of osteoporosis in men.
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The Health Belief Model, social learning theory (recently relabelled social cognitive theory), self-efficacy, and locus of control have all been applied with varying success to problems of explaining, predicting, and influencing behavior. Yet, there is conceptual confusion among researchers and practitioners about the interrelationships of these theories and variables. This article attempts to show how these explanatory factors may be related, and in so doing, posits a revised explanatory model which incorporates self-efficacy into the Health Belief Model. Specifically, self-efficacy is proposed as a separate independent variable along with the traditional health belief variables of perceived susceptibility, severity, benefits, and barriers. Incentive to behave (health motivation) is also a component of the model. Locus of control is not included explicitly because it is believed to be incorporated within other elements of the model. It is predicted that the new formulation will more fully account for health-related behavior than did earlier formulations, and will suggest more effective behavioral interventions than have hitherto been available to health educators.
Article
The purpose of this theory-based descriptive study was to describe older men's (> or = 65 years of age) knowledge of osteoporosis, their health beliefs about osteoporosis (specifically their perceived susceptibility), their confidence to perform osteoporosis-prevention behaviors, and actual performance of osteoporosis-prevention behaviors. A descriptive design was used to determine men's knowledge and health beliefs of osteoporosis, confidence to perform osteoporosis prevention behaviors, and performance of osteoporosis prevention behaviors. A community-based convenience sample of 138 men 65 years of age and older was obtained in Northeastern Ohio community centers where men were likely to gather. Men completed a questionnaire that included the Osteoporosis Knowledge Test, Osteoporosis Health Belief Scale, Osteoporosis Self-Efficacy Scale (Kim, Horan & Gendler, 1991), and the Osteoporosis Preventing Behaviors Survey (Doheny & Sedlak, 1995). MAIN RESEARCH CLASSIFICATIONS: Osteoporosis, Men, Prevention, Health Beliefs, Orthopaedic Nursing. Men had poor knowledge of osteoporosis, did not perceive themselves as susceptible to osteoporosis, and engaged in few osteoporosis preventing behaviors such as weight-bearing exercises and dietary calcium intake. Men need osteoporosis education and modification of lifestyle to include osteoporosis prevention behaviors. Future research should include the development of osteoporosis awareness programs for men.
Article
Osteoporosis and vertebral fractures are a consequence of glucocorticoid immunosuppression therapy in lung transplant recipients (LTR). The purpose of this study was to determine the therapeutic efficacy of a 6-month program of specific resistance exercise designed to reverse glucocorticoid-induced vertebral osteoporosis. Sixteen lung transplant candidates were randomly and prospectively assigned to a group (n=8) that performed 6 months of exercise on a lumbar extensor machine or to a control group (n=8). Resistance exercise was initiated at 2 months after transplantation. Bone mineral density (BMD) of the lumbar vertebra (L2-3) was assessed using a dual-energy X-ray absorptiometer (DXA). DXA scans were performed before and 2 months after transplantation and after 6 months of lumbar extensor training or control period. Lumbar BMD did not differ (P>0.05) between the two groups at study entry. Both the trained (0.63 to 0.54 g/cm2 of hydroxyapatite) and control groups (0.62 to 0.53 g/cm2 of hydroxyapatite) lost significant and comparable amounts (-14.5%) of BMD between study entry and 2 months posttransplantation. The control group lost further (P<or=0.05) lumbar BMD between 2 and 8 months posttransplantation (0.53 to 0.50 g/cm2 of hydroxyapatite), decreasing to values that were 19.5% less than pretransplantation baseline. Lumbar BMD in the trained group increased significantly (+9.2%) after 6 months (0.54 to 0.60 g/cm2 of hydroxyapatite) and returned to values that were within 5% of pretransplantation baseline. Mechanical loading associated with progressive resistance exercise, using a specific exercise that isolated the lumbar spine, was efficacious in preventing steroid-induced osteoporosis in LTR.
Article
The diagnosis and treatment of patients at risk of fragility fractures is uncommon. We examined the patient, physician, and practice characteristics associated with adherence to local osteoporosis guidelines. Data were obtained from electronic medical records from one academic medical center. Local guidelines suggest screening and consideration of treatment for at-risk patients, including women aged > or =65 years, women aged 50 to 64 years who smoke cigarettes, persons who used more than 5 mg of oral prednisone for >3 months, and those with a history of a fracture after age 45 years. Clinical notes, medication lists, and radiology records were reviewed to determine whether patients had undergone bone mineral density testing or received any medications for osteoporosis. Possible correlates of guideline adherence, including patient, physician, and practice site characteristics, were assessed in mixed multivariable models. We identified 6311 at-risk patients seen by 160 doctors at 10 primary care sites during 2001 to 2002. Of these patients, 45% (n = 2820) had a prior bone mineral density test and 30% (n = 1922) had received a medication for osteoporosis; 54% (n = 3401) had one or the other. After adjusting for patient case mix, 17% to 71% of patients had been managed according to local guidelines and had undergone at least bone mineral density testing or received a medication. Patient variables that significantly lowered the probability of guideline adherence included age >74 years (odds ratio [OR] = 0.49; 95% confidence interval [CI]: 0.43 to 0.55), age <55 years (OR = 0.34; 95% CI: 0.28 to 0.42), male sex (OR = 0.17; 95% CI: 0.12 to 0.23), black race (OR = 0.40; 95% CI: 0.34 to 0.47), and having more than one comorbid condition (OR = 0.79; 95% CI: 0.69 to 0.89). Patients seen by male physicians were less likely to have care that was adherent with guidelines (OR = 0.70; 95% CI: 0.55 to 0.89). Rates of adherence with local osteoporosis guidelines for patients at risk of fragility fractures vary by patient, physician, and practice site characteristic.
Article
Bone mass is a major determinant of fracture, but there have been few comprehensive studies of the correlates of bone mineral density (BMD) in older men. The objective of the current cross-sectional analysis was to determine the factors associated with BMD of the lumbar spine and proximal femur in a large population-based sample of older men enrolled in The Osteoporotic Fractures in Men Study, "Mr.OS." We enrolled 5,995 men 65 years of age or older, 89% Caucasian, in Mr.OS at six US clinical centers. Demographic, medical and family history and lifestyle information was obtained by interview and physical function and anthropometric data by examination. Spine and hip BMD was measured using dual-energy X-ray absorptimetry. The multivariable linear regression models predicted 19 and 10% of the overall variance in BMD of the femoral neck and spine, respectively. African-American men had 6 to 11% higher BMD than Caucasian men independent of multiple factors. Hip BMD declined with advancing age, while spine BMD increased. Body weight (per 10 kg) and self report of diabetes were each associated with 2 to 4% higher BMD, while history of a non-trauma fracture and current use of selective serotonin reuptake inhibitors, but not other antidepressants, were associated with at least 4% lower BMD. Both maternal and paternal histories of fracture were associated with 1.4-1.7% lower BMD. Osteoarthritis, physical activity, grip strength, alcohol intake, and dietary calcium were positively related to BMD, while a history of chronic lung disease, prostate cancer, and kidney stones was associated with lower BMD. Smoking, caffeine intake, and thiazide diuretics were not related to BMD in older men. A number of lifestyle and behavioral characteristics and medical conditions were associated with BMD in older men. Identification of these correlates could improve methods to identify men at risk for fracture and improve our understanding of fracture etiology.
Article
The burden of osteoporotic fractures in older men is significant. The objectives of our study were to: (1) characterize older men with fractures associated with osteoporosis, (2) determine if medication treatment rates for osteoporosis are improving and (3) identify patient, healthcare benefit and utilization, and clinician characteristics that are significantly associated with treatment. This retrospective cohort study assessed 1,171 men aged 65 or older with any new fracture associated with osteoporosis between 1 January 1998 and 30 June 2001 in a non-profit health maintenance organization in the United States. Multiple logistic regression was used to evaluate pre-fracture factors for their association with osteoporosis treatment in the 6-month post-fracture period. The main outcome measure was pharmacologic treatment for osteoporosis in the 6 months after the index fracture. Subjects' average age was 76.7 years; 3.3% had a diagnosis of osteoporosis and 15.2% a diagnosis or medication associated with secondary osteoporosis. Only 7.1% of the study population and 16.0% of those with a hip or vertebral fracture received a medication for osteoporosis following the index fracture, and treatment rates did not improve over time. In the multivariate model, factors significantly associated with drug treatment were a higher value on the Charlson Comorbidity Index (odds ratio 1.26, 95% confidence interval 1.05-1.51), having an osteoporosis diagnosis (odds ratio 8.11, 95% confidence interval 3.08-21.3), chronic glucocorticoid use (odds ratio 5.37, 95% confidence interval 2.37-12.2) and a vertebral fracture (odds ratio 16.6, 95% confidence interval 7.8-31.4). Bone mineral density measurement was rare (n =13, 1.1%). Our findings suggest that there is under-ascertainment and under-treatment of osteoporosis and modifiable secondary causes in older men with fractures. Information systems merging diagnostic and treatment information can help delineate gaps in patient management. Interventions showing promise in other conditions should be evaluated to improve care for osteoporosis.
Article
Large, long term research studies present recruitment challenges that can be met with collaborative approaches to identify and enroll participants. The Osteoporotic Fractures in Men Study (MrOS), a multi-center observational study designed to determine risk factors for osteoporosis, fractures and prostate cancer in older men, recruited 5995 participants over a 25-month period. Enrolling a cohort that represented the race and age distribution of each community, and developing interest in an older male cohort about a condition commonly thought of as a "women's disease," were major recruitment challenges. During the start-up phase, recruitment challenges and strategies were analyzed and collective approaches were developed to address ways to motivate the target population. Key methods included mailings using community and provider contact lists; regional and senior newspaper advertisements; and presentations targeted to seniors. Sites used a centrally developed recruitment brochure. Response to mass mailings at some sites surpassed 10-15% and appointment show rates averaged above 85%. The final number enrolled in MrOS was 5% more than the original recruitment goal of 5700. Minority recruitment was enhanced through the use of the Health Care Financing Administration and other databases that allowed for targeted recruitment. Overall, minority enrollment was approximately 10.56% of the cohort (244 African American, 191 Asian). Men age>80 were enthusiastic and represent about 18% of enrollees. Through a coordinated approach of developing and refining recruitment strategies and materials, sites were able to adapt their original strategies and complete recruitment ahead of schedule.
Article
Background: Chronic consumption of excessive alcohol eventually results in an osteopenic skeleton and increased risk for osteoporosis. Alcoholics experience not only increased incidence of fractures from falls, but also delays in fracture healing compared with non-alcoholics. In this review the term "alcohol-induced bone disease" is used to refer to these skeletal abnormalities. Alcohol-induced osteopenia is distinct from osteoporoses such as postmenopausal osteoporosis and disuse osteoporosis. Gonadal insufficiency increases the rate of bone remodeling, whereas alcohol decreases this rate. Thus, histomorphometric studies show different characteristics for the bone loss that occurs in these two disease states. In particular, alcohol-induced osteopenia results mainly from decreased bone formation rather than increased bone resorption. Human, animal and cell culture studies of the effects of alcohol on bone strongly suggest alcohol has a dose-dependent toxic effect on osteoblast activity. The capacity of bone marrow stromal cells to differentiate into osteoblasts has a critical role in the cellular processes involved in the maintenance of the adult human skeleton by bone remodeling. Chronic alcohol consumption suppresses osteoblastic differentiation of bone marrow cells and promotes adipogenesis. In fracture healing, the effect of alcohol is to suppress synthesis of an ossifiable matrix, possibly due to inhibition of cell proliferation and maldifferentiation of mesenchymal cells in the repair tissue. This results in the deficient bone repair observed in animal studies, characterized by repair tissue of lower stiffness, strength and mineral content. Current knowledge of cellular effects and molecular mechanisms involved in alcohol-induced bone disease is insufficient to develop interventional strategies for its prevention and treatment. Objectives: The objectives of this review are 1) to identify the characteristics of alcohol-induced bone loss and deficient bone repair as revealed in human and animal studies, 2) to determine the current understanding of the cellular effects underlying both skeletal abnormalities, and 3) to suggest directions for future studies to resolve current ambiguities regarding the cellular basis of alcohol-induced bone disease.
Article
Osteoporosis is a significant threat to aging bone in men. Thirty percent of hip fractures occur in men; during initial hospitalization and the first year after fracture, the mortality rate is twice that of women. Nevertheless, osteoporosis in men is grossly underdiagnosed and undertreated. The most frequent factors associated with osteoporosis in men are age >75 years, low baseline body mass index (<24 kg/m(2)), weight loss >5% over 4 years, current smoking, and physical inactivity. Osteoporosis in men is either secondary to a primary disease or is idiopathic. It exhibits a bimodal age distribution, with peaks at age 50 years (secondary disease) and at age 70 years (idiopathic). Prevention and early detection currently are the best forms of management. Alone or in combination, calcium, vitamin D, bisphosphonates, and human parathyroid hormone are all effective management options. In the acute setting of fragility fracture, the orthopaedic surgeon is key in identifying patients at risk because the surgeon provides primary care and may initiate prophylactic measures to prevent future fractures.
Article
Osteoporosis is an important public health issue among men, affecting up to 20% of all men in the United States >50 years of age. The social and economic costs of male osteoporosis are profound but can be minimized by a preventive approach, including early identification and treatment of men at risk for this potentially crippling disease. As part of this preventive approach, clinicians should screen susceptible patients for vitamin D deficiency, a commonly occurring, highly correctable risk factor for osteoporosis. Appropriate detection of vitamin D deficiency in men at risk for osteoporosis and adequate correction of this deficiency will significantly reduce morbidity and mortality associated with male osteoporosis.
Article
Male osteoporosis is a relatively unknown condition for many physicians. Yet about 500,000 fractures happen in men every year. For comparison, prostate cancer is diagnosed in 200,000 men annually. Mortality rate during the first year of hip fracture is higher than 30%, and 50% of patients do not regain their previous mobility and independence. This review focuses on epidemiology, underling causes, diagnostic tools, and treatment of male osteoporosis and prevention of fractures.
Article
Women are not aggressively treated for osteoporosis after hip fracture; the treatment status of men with hip fracture has not been extensively studied. To evaluate the outcome and treatment status of men with hip fracture. Data from medical records were obtained for 363 patients (110 men and 253 women) aged 50 years and older with atraumatic (low-energy) hip fracture who were admitted to St Luke's Episcopal Hospital between January 1, 1996, and December 31, 2000. Surveys were mailed to surviving patients. Main outcome variables were osteoporosis treatments (antiresorptive or calcium and vitamin D) at hospital discharge, current osteoporosis treatments at 1- to 5-year follow-up, bone mineral density testing, mortality, current disability, and living arrangements (home or institution). The mean age for men was 80 years vs 81 years for women. Most fractures (89% for men and 93% for women) resulted from falls from a standing height. At hospital discharge, 4.5% of men (n = 5) had treatment of any kind for osteoporosis, compared with 27% of women (n = 69) (P<.001). The 12-month mortality was 32% in men, compared with 17% in women (P =.003). Surveys were usable from 168 (87%) of 194 survivors. At 1- to 5-year follow-up, 27% (12/44) of men were taking treatment of any kind for osteoporosis, compared with 71% (88/124) of women (P<.001). Of those treated, 67% (8/12) of men and 32% (28/88) of women were taking calcium and vitamin D only. At 1- to 5-year follow-up, 11% of men had a bone mineral density measurement, compared with 27% of women. After hospital discharge, the number of men and women who required wheelchairs, walkers, and canes and who lived in institutions increased significantly. The burden of hip fracture is illustrated by the high incidence of postfracture disability and the high mortality rate in both men and women. Nevertheless, few men receive antiresorptive treatment.