Osteoporosis in Men and Women: The Current Perspectives on Prevention and Treatment
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Osteoporosis, which has been defined by WHO as low bone mineral density(BMD) as that T-score are 2.5 standard deviations(SD) or more below the young-adults, is one of the major health problems particularly among the older men and postmenopausal women. WHO has defined osteoporosis using BMD of postmenopausal Caucasian women as T≤-2.5. It is recommended that BMD measurement is not for routine screening, but for those indicated. Maximum peak bone mass is an important factor for bone health and is mostly genetically determined. Nevertheless, sex hormone, particularly E-2, is important in peak bone mass acquisition and age related bone loss. Hormone therapy can increase BMD and reduce fracture risk in hypogonadal men and women. Constitutionally, men have greater peak bone mass and larger bone than women. In addition, hormone decline rapidly with menopause and gradually with andropause. Thus, aging bone loss accelerates earlier in women(50 y/o) than in men(70 y/o) and more osteoporosis in women than in men. These result in more osteoporotic hip fracture in women, but higher post-fracture mortality in men. The North American Menopause Society(NAMS) has developed guidelines recommending that drug therapy should be considered in: 1) All postmenopausal women who have had an osteoporotic vertebral fracture. 2) All postmenopausal women with BMD values consistent with osteoporosis(i.e., T-score ≤-2.5). 3) All postmenopausal women with T-score from -2.0 to -2.5 plus low body weight, history of fragility fracture since menopause, or a history of hip fracture in a parent. Further, it has been agreed that there is no definitive information for determining which drug for which patient to use. The decision of which drug to use should be made individually for each patient based on those information, such as, risk vs benefit, compliance, patient preference, and may be insurance coverage.
Abstract
Osteoporosis, which has been defined by WHO as low bone mineral density(BMD) as that T-score are 2.5 standard deviations(SD) or more below the young-adults, is one of the major health problems particularly among the older men and postmenopausal women. WHO has defined osteoporosis using BMD of postmenopausal Caucasian women as T≤-2.5. It is recommended that BMD measurement is not for routine screening, but for those indicated. Maximum peak bone mass is an important factor for bone health and is mostly genetically determined. Nevertheless, sex hormone, particularly E-2, is important in peak bone mass acquisition and age related bone loss. Hormone therapy can increase BMD and reduce fracture risk in hypogonadal men and women. Constitutionally, men have greater peak bone mass and larger bone than women. In addition, hormone decline rapidly with menopause and gradually with andropause. Thus, aging bone loss accelerates earlier in women(50 y/o) than in men(70 y/o) and more osteoporosis in women than in men. These result in more osteoporotic hip fracture in women, but higher post-fracture mortality in men. The North American Menopause Society(NAMS) has developed guidelines recommending that drug therapy should be considered in: 1) All postmenopausal women who have had an osteoporotic vertebral fracture. 2) All postmenopausal women with BMD values consistent with osteoporosis(i.e., T-score ≤-2.5). 3) All postmenopausal women with T-score from -2.0 to -2.5 plus low body weight, history of fragility fracture since menopause, or a history of hip fracture in a parent. Further, it has been agreed that there is no definitive information for determining which drug for which patient to use. The decision of which drug to use should be made individually for each patient based on those information, such as, risk vs benefit, compliance, patient preference, and may be insurance coverage.
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