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Risk factors for low BMD in healthy men age 50 years or older: a systematic review

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Abstract

Summary

In this systematic review, we summarize risk factors for low bone mineral density and bone loss in healthy men age 50 years or older. Consistent risk factors were: age, smoking, low weight, physical/functional limitations, and previous fracture. Data specific to men has clinical and policy implications.

Introduction

Osteoporosis is a significant health care problem in men as well as women, yet the majority of evidence on diagnosis and management of osteoporosis is focused on postmenopausal women. The objective of this systematic review is to examine risk factors for low bone mineral density (BMD) and bone loss in healthy men age 50 years or older.

Materials and methods

A systematic search for observational studies was conducted in MEDLINE, Cochrane Database of Systematic Reviews, DARE, CENTRAL, CINAHL and Embase, Health STAR. The three main search concepts were bone density, densitometry, and risk factors. Trained reviewers assessed articles using a priori criteria.

Results

Of 642 screened abstracts, 299 articles required a full review, and 25 remained in the final assessment. Consistent risk factors for low BMD/bone loss were: advancing age, smoking, and low weight/weight loss. Although less evidence was available, physical/functional limitations and prevalent fracture (after age 50) were also associated with low BMD/bone loss. The evidence was inconsistent or weak for physical activity, alcohol consumption, calcium intake, muscle strength, family history of fracture/osteoporosis, and height/height loss.

Conclusion

In this systematic review, we identified several risk factors for low BMD/bone loss in men that are measurable in primary practice.

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References

  1. World Health Organization (WHO) (2003) Prevention and management of osteoporosis. World Health Organization, Geneva No. 921

    Google Scholar 

  2. Tenenhouse A, Joseph L, Kreiger N et al (2000) Estimation of the prevalence of low bone density in Canadian women and men using a population-specific DXA reference standard: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 11:897–904

    Article  PubMed  CAS  Google Scholar 

  3. Szulc P, Munoz F, Duboeuf F et al (2005) Bone mineral density predicts osteoporotic fractures in elderly men: the MINOS study. Osteoporos Int 16:1184–1192

    Article  PubMed  Google Scholar 

  4. Johnell O, Kanis JA, Oden A et al (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194

    Article  PubMed  Google Scholar 

  5. Cummings SR, Cawthon PM, Ensrud KE et al (2006) BMD and risk of hip and nonvertebral fractures in older men: a prospective study and comparison with older women. J Bone Miner Res 21:1550–1556

    Article  PubMed  Google Scholar 

  6. Papaioannou A, Wiktorowicz ME, Adachi JD et al (2000) Mortality, independence in living, and re-fracture, one year following hip fracture in Canadians. J Obstet Gynaecol Can 22:591–597

    Google Scholar 

  7. de Laet CE, van Hout BA, Burger H et al (1997) Bone density and risk of hip fracture in men and women: cross sectional analysis. BMJ 315:221–225

    PubMed  Google Scholar 

  8. Jackson SA, Tenenhouse A, Robertson L (2000) Vertebral fracture definition from population-based data: preliminary results from the Canadian Multicenter Osteoporosis Study (CaMos). Osteoporos Int 11:680–687

    Article  PubMed  CAS  Google Scholar 

  9. Center JR, Nguyen TV, Schneider D et al (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882

    Article  PubMed  CAS  Google Scholar 

  10. Endo Y, Aharonoff GB, Zuckerman JD et al (2005) Gender differences in patients with hip fracture: a greater risk of morbidity and mortality in men. J Orthop Trauma 19:29–35

    Article  PubMed  Google Scholar 

  11. Osnes EK, Lofthus CM, Meyer HE et al (2004) Consequences of hip fracture on activities of daily life and residential needs. Osteoporos Int 15:567–574

    Article  PubMed  CAS  Google Scholar 

  12. National Osteoporosis Foundation (NOF) (2008) Clinician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington, DC

    Google Scholar 

  13. Harris RP, Helfand M, Woolf SH et al (2001) Current methods of the US Preventive Services Task Force: a review of the process. Am J Prev Med 20:21–35

    Article  PubMed  CAS  Google Scholar 

  14. Yoshimura N, Hashimoto T, Morioka S et al (1998) Determinants of bone loss in a rural Japanese community: the Taiji Study. Osteoporos Int 8:604–610

    Article  PubMed  CAS  Google Scholar 

  15. Yoshimura N, Kinoshita H, Danjoh S et al (2002) Bone loss at the lumbar spine and the proximal femur in a rural Japanese community, 1990–2000: the Miyama study. Osteoporos Int 13:803–808

    Article  PubMed  CAS  Google Scholar 

  16. Cheung EY, Ho AY, Lam KF et al (2005) Determinants of bone mineral density in Chinese men. Osteoporos Int 16:1481–1486

    Article  PubMed  CAS  Google Scholar 

  17. Kung AW, Ho AY, Ross PD et al (2005) Development of a clinical assessment tool in identifying Asian men with low bone mineral density and comparison of its usefulness to quantitative bone ultrasound. Osteoporos Int 16:849–855

    Article  PubMed  Google Scholar 

  18. Lau EM, Leung PC, Kwok T et al (2006) The determinants of bone mineral density in Chinese men—results from Mr. Os (Hong Kong), the first cohort study on osteoporosis in Asian men. Osteoporos Int 17:297–303

    Article  PubMed  CAS  Google Scholar 

  19. Lynn HS, Lau EM, Wong SY et al (2005) An osteoporosis screening tool for Chinese men. Osteoporos Int 16:829–834

    Article  PubMed  CAS  Google Scholar 

  20. Cauley JA, Fullman RL, Stone KL et al (2005) Factors associated with the lumbar spine and proximal femur bone mineral density in older men. Osteoporos Int 16:1525–1537

    Article  PubMed  Google Scholar 

  21. Hannan MT, Felson DT, Dawson-Hughes B et al (2000) Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res 15:710–720

    Article  PubMed  CAS  Google Scholar 

  22. Dennison E, Eastell R, Fall CH et al (1999) Determinants of bone loss in elderly men and women: a prospective population-based study. Osteoporos Int 10:384–391

    Article  PubMed  CAS  Google Scholar 

  23. Burger H, de Laet CE, van Daele PL et al (1998) Risk factors for increased bone loss in an elderly population: the Rotterdam Study. Am J Epidemiol 147:871–879

    PubMed  CAS  Google Scholar 

  24. Knoke JD, Barrett-Connor E (2003) Weight loss: a determinant of hip bone loss in older men and women. The Rancho Bernardo Study. Am J Epidemiol 158:1132–1138

    Article  PubMed  Google Scholar 

  25. Szulc P, Marchand F, Duboeuf F et al (2000) Cross-sectional assessment of age-related bone loss in men: the MINOS study. Bone 26:123–129

    Article  PubMed  CAS  Google Scholar 

  26. Lunt M, Felsenberg D, Adams J et al (1997) Population-based geographic variations in DXA bone density in Europe: the EVOS Study. European Vertebral Osteoporosis. Osteoporos Int 7:175–189

    Article  PubMed  CAS  Google Scholar 

  27. Bendavid EJ, Shan J, Barrett-Connor E (1996) Factors associated with bone mineral density in middle-aged men. J Bone Miner Res 11:1185–1190

    PubMed  CAS  Google Scholar 

  28. Orwoll ES, Bevan L, Phipps KR (2000) Determinants of bone mineral density in older men. Osteoporos Int 11:815–821

    Article  PubMed  CAS  Google Scholar 

  29. Naves M, Diaz-Lopez JB, Gomez C et al (2005) Prevalence of osteoporosis in men and determinants of changes in bone mass in a non-selected Spanish population. Osteoporos Int 16:603–609

    Article  PubMed  CAS  Google Scholar 

  30. Nguyen TV, Kelly PJ, Sambrook PN et al (1994) Lifestyle factors and bone density in the elderly: implications for osteoporosis prevention. J Bone Miner Res 9:1339–1346

    Article  PubMed  CAS  Google Scholar 

  31. Kiel DP, Zhang Y, Hannan MT et al (1996) The effect of smoking at different life stages on bone mineral density in elderly men and women. Osteoporos Int 6:240–248

    Article  PubMed  CAS  Google Scholar 

  32. Szulc P, Garnero P, Claustrat B et al (2002) Increased bone resorption in moderate smokers with low body weight: the Minos study. J Clin Endocrinol Metab 87:666–674

    Article  PubMed  CAS  Google Scholar 

  33. May H, Murphy S, Khaw KT (1994) Cigarette smoking and bone mineral density in older men. QJM 87:625–630

    PubMed  CAS  Google Scholar 

  34. Huuskonen J, Vaisanen SB, Kroger H et al (2000) Determinants of bone mineral density in middle aged men: a population-based study. Osteoporos Int 11:702–708

    Article  PubMed  CAS  Google Scholar 

  35. Nguyen TV, Center JR, Eisman JA (2000) Osteoporosis in elderly men and women: effects of dietary calcium, physical activity, and body mass index. J Bone Miner Res 15:322–331

    Article  PubMed  CAS  Google Scholar 

  36. Lunt M, Masaryk P, Scheidt-Nave C et al (2001) The effects of lifestyle, dietary dairy intake and diabetes on bone density and vertebral deformity prevalence: the EVOS study. Osteoporos Int 12:688–698

    Article  PubMed  CAS  Google Scholar 

  37. May H, Murphy S, Khaw KT (1995) Alcohol consumption and bone mineral density in older men. Gerontology 41:152–158

    Article  PubMed  CAS  Google Scholar 

  38. Looker AC, Beck TJ (2004) Maternal history of osteoporosis and femur geometry. Calcif Tissue Int 75:277–285

    Article  PubMed  CAS  Google Scholar 

  39. Diamond TH, Higano CS, Smith MR et al (2004) Osteoporosis in men with prostate carcinoma receiving androgen-deprivation therapy: recommendations for diagnosis and therapies. Cancer 100:892–899

    Article  PubMed  Google Scholar 

  40. van Staa TP, Leufkens HG, Cooper C (2002) The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 13:777–787

    Article  PubMed  Google Scholar 

  41. Shahinian VB, Kuo YF, Freeman JL et al (2005) Risk of fracture after androgen deprivation for prostate cancer. N Engl J Med 352:154–164

    Article  PubMed  CAS  Google Scholar 

  42. Vestergaard P, Olsen ML, Paaske JS et al (2003) Corticosteroid use and risk of hip fracture: a population-based case-control study in Denmark. J Intern Med 254:486–493

    Article  PubMed  CAS  Google Scholar 

  43. Nelson HD, Morris CD, Kraemer DF, Mahon S, Carney N, Nygren PM, Helfand M, and Oregon Health & Science University Evidence-based Practice Center (2001) Osteoporosis in postmenopausal women: diagnosis and monitoring. AHRQ Publication No. 01-E032 Agency for Healthcare Research and Quality, Rockville, MD

  44. Brown JP, Josse RG (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167:S1–34

    PubMed  Google Scholar 

  45. Khan AA, Hodsman AB, Papaioannou A et al (2007) Management of osteoporosis in men: an update and case example. CMAJ 176:345–348

    PubMed  Google Scholar 

  46. Siminoski K, Leslie WD, Frame H et al (2005) Recommendations for bone mineral density reporting in Canada. Can Assoc Radiol J 56:178–188

    PubMed  Google Scholar 

  47. De Laet C, Kanis JA, Oden A et al (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 16:1330–1338

    Article  PubMed  Google Scholar 

  48. Kanis JA, Johansson H, Oden A et al (2004) A family history of fracture and fracture risk: a meta-analysis. Bone 35:1029–1037

    Article  PubMed  CAS  Google Scholar 

  49. Kanis JA, Johansson H, Oden A et al (2005) A meta-analysis of milk intake and fracture risk: low utility for case finding. Osteoporos Int 16:799–804

    Article  PubMed  Google Scholar 

  50. Kanis JA, Johansson H, Johnell O et al (2005) Alcohol intake as a risk factor for fracture. Osteoporos Int 16:737–742

    Article  PubMed  Google Scholar 

  51. Kanis JA, Johnell O, De Laet C et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382

    Article  PubMed  CAS  Google Scholar 

  52. Kanis JA, Johnell O, Oden A et al (2005) Smoking and fracture risk: a meta-analysis. Osteoporos Int 16:155–162

    Article  PubMed  CAS  Google Scholar 

  53. Kanis JA, Johansson H, Oden A et al (2004) A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 19:893–899

    Article  PubMed  Google Scholar 

  54. Kanis JA, Johnell O, Oden A et al (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397

    Article  PubMed  CAS  Google Scholar 

  55. World Health Organization Collaborating Centre for Metabolic Bone Diseases (2008) WHO Fracture Risk Assessment Tool (FRAX). www.shef ac uk/FRAX/

  56. Orwoll E, Blank JB, Barrett-Connor E et al (2005) Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study—a large observational study of the determinants of fracture in older men. Contemp Clin Trials 26:569–585

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Chistina Lachetti, Kristina Szabo, and Nicole Zytaruk for data abstraction, and Lois Wyndham for literature review and library assistance.

This project was funded by the Ontario Ministry of Health and Long-Term Care, Ontario Osteoporosis Strategy.

Conflicts of interest

Alexandra Papaioannou, MD, FRCPC, MSc

Consulting and Advisory Role: Amgen, Eli Lilly, Merck Frosst, Novartis, Proctor & Gamble, Sanofi-aventis, Servier

Clinical Trials: Amgen, Eli Lilly, Merck, Novartis, Proctor & Gamble, Sanofi-aventis

Ann Cranney, MD, FRCPC, MSc has received honoraria for educational lectures from Merck Frosst, Alliance for Bone Health and Novartis; and consultant fees from Amgen Canada and Research funding from Hofmann La Roche.

Jacques P. Brown, MD, FRCPC has received honoraria for lecturing, consultancies, grants and research support for clinical trials: Abbott, Alpharx, Amgen, Arthrolab, Sanofi-aventis Canada, Boehringer Ingelheim/Roche, Bristol-Myers Squibb, Celltech, Eli Lilly Canada, Genizon, Glaxosmithkline, Merck Frosst, Nicox, Novartis, NPS Pharma, Pfizer, Proctor & Gamble, Quintiles, Rhône-Poulenc Rorer, Servier, Wyeth, Zelos.

Stephanie M Kaiser, MD, FRCPC

Advisory Boards: Amgen, Eli Lilly, Novartis, Wyeth-Ayerst, Servier

Speaker for: Amgen, Eli Lilly, Novartis, Merck, Procter & Gamble/Sanofi-aventis, AstraZeneca, Servier

William D. Leslie, MD, FRCPC, MSc

Speaker fees, research honoraria, and unrestricted research grants: Merck Frosst Canada Ltd; research honoraria and unrestricted educational grants from The Alliance for Better Bone Health: Sanofi-aventis and Procter & Gamble Pharmaceuticals Canada, Inc.; unrestricted research grants from Novartis Pharmaceuticals Canada, Inc.; unrestricted educational grants from Genzyme Canada

Aliya Khan

Consulting Role: Proctor & Gamble, Merck Frosst, Novartis

Research: Proctor & Gamble, Merck Frosst, Servier, Amgen, Eli Lilly

Jonathan D. Adachi, MD

Consulting Role: Amgen; Astra Zeneca, Eli Lilly; GlaxoSmithKline; Merck Frosst; Novartis; Proctor & Gamble; Roche; Sanofi-aventis; Servier

Clinical Trials: Eli Lilly; GlaxoSmithKline; Merck; Novartis; Pfizer; Proctor & Gamble; Sanofi-aventis; Servier; Wyeth-Ayerst

Courtney C. Kennedy, MSc; Gillian Hawker MD, MSc, FRCPC; Anna M. Sawka MD, FRCPC, PhD; Kerry Siminoski, MD, FRCPC; David Webster, MD, FRCP; Jessie McGowan MLIS: No competing interests to declare.

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Authors and Affiliations

  1. Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada

    A. Papaioannou

  2. Department of Medicine, McMaster University, Hamilton, Ontario, Canada

    C. C. Kennedy

  3. Division of Rheumatology, University of Ottawa, Scientist, Clinical Epidemiology, Ottawa Health Research Institute, Ottawa, Ontario, Canada

    A. Cranney

  4. Women’s College Hospital, Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    G. Hawker

  5. Department of Medicine, Université Laval and Head of the Division of Rheumatology at Le Centre Hospitalier Universitaire de Québec, Quebec, Québec, Canada

    J. P. Brown

  6. Division of Endocrinology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

    S. M. Kaiser

  7. Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada

    W. D. Leslie

  8. Department of Nuclear Medicine, Brantford General Hospital, Brantford, Ontario, Canada

    C. J. M. O’Brien

  9. Division of Endocrinology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada

    A. M. Sawka

  10. Division of Endocrinology and Geriatrics, Department of Medicine, McMaster University, Hamilton, Ontario, Canada

    A. Khan

  11. Department of Radiology and Diagnostic Imaging and Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Alberta, Edmonton, Alberta, Canada

    K. Siminoski

  12. Department of Medical Imaging, Humber Regional Hospital, Toronto, Ontario, Canada

    G. Tarulli

  13. Department of Nuclear Medicine, Sudbury Regional Hospital, Sudbury, Ontario, Canada

    D. Webster

  14. Institute of Population Health, Adjunct Professor, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

    J. McGowan

  15. Alliance for Better Bone Health Chair in Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada

    J. D. Adachi

  16. McMaster University, Hamilton Health Sciences, Chedoke Site, Building 74, Room 5, Hamilton, Ontario, L9C 7N4, Canada

    A. Papaioannou

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  1. A. Papaioannou
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  2. C. C. Kennedy
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  3. A. Cranney
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  4. G. Hawker
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  5. J. P. Brown
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  6. S. M. Kaiser
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  7. W. D. Leslie
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  8. C. J. M. O’Brien
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  9. A. M. Sawka
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  10. A. Khan
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  11. K. Siminoski
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  13. D. Webster
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  14. J. McGowan
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  15. J. D. Adachi
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Corresponding author

Correspondence to A. Papaioannou.

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For the Male BMD Guidelines Committee of Osteoporosis Canada

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Papaioannou, A., Kennedy, C.C., Cranney, A. et al. Risk factors for low BMD in healthy men age 50 years or older: a systematic review. Osteoporos Int 20, 507–518 (2009). https://doi.org/10.1007/s00198-008-0720-1

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  • DOI: https://doi.org/10.1007/s00198-008-0720-1

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