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Osteoporosis in Elderly Men Underestimated: Presented at ENDO

By Paula Moyer

Special to DG News

SAN FRANCISCO, CA -- June 24, 2002 -- As many as 30 percent of men over 65 years old may have osteoporosis, according to a study presented at ENDO 2002, the 84^th annual meeting of the Endocrine Society.

The investigators reviewed the charts of 521 consecutive men who had been admitted to the rehabilitation unit of a Veterans Administration (VA) nursing home in northern California that was affiliated with the VA Northern California Health Care System, in Martinez, California..

Of the 521 charts reviewed, 32 patients had already been screened or were receiving therapy for osteoporosis (6.1 percent). The investigators recruited the remainder to be evaluated for osteoporosis. They excluded patients that were too ill or too demented to cooperate, as well as those who had cancer that had metastasised to bone and those who chose not to participate.

Among those, the investigators have now evaluated 76 patients. The investigators obtained bone density of the hip and lumbar spine by dual X-ray absorptiometry (DEXA) and routine clinical biochemistry studies.

Of the 76, 23 (30.5 percent) had osteoporosis, which was defined as a T-score of <-2.5. The average hip T-score in men with osteoporosis was -3.0±0.55. In the men with no osteoporosis, the average hip T-score was -0.71±1.2 (p<0.05). The average spine T-score was lower in men with osteoporosis, -0.93±1.9, compared to an average spine T-score of 0.21±1.5 for men with no osteoporosis (p<0.05). However, many of the men with hip osteoporosis had spine T-scores in the normal range, the investigators said.

The average ages of both groups were comparable, 69.1±14.7 for men with osteoporosis and 65.3.1±11.6 for men with no osteoporosis. The values for testosterone and PTH were normal and not significantly different between the two populations. The average 25-OH-vitamin D level was low in both groups; for the men with osteoporosis, the average level was 22.1±10.2; for those with no osteoporosis, the average level was 21.6±11. Similarly, the 24-hour urinary calcium level was low, an average of 97.1±97.3 for men with osteoporosis and 71.6±62.4 for men with no osteoporosis. The differences in the groups' scores were insignificant, the investigators reported.

The serum thyroid-stimulating hormone (TSH), although normal, was slightly lower in men with osteoporosis, an average of 1.57±0.74 in comparison to an average of 2.34±1.93 in men with no osteoporosis (p<0.05). Hip and spine bone density were correlated (r=0.3, p<0.05).

"Hip osteoporosis is more common than anticipated in this unscreened population," the investigators stated, noting that the findings suggest physicians should screen elderly men more widely. Because both groups of men have low-normal 25-OH vitamin D, and low urinary calcium, the investigators suggest that patients in their situation, could benefit from enhancing their nutritional status.

"We found that, although 6.8 percent of the patients had been screened for osteoporosis and were being treated for it, approximately one-third of them have it," said lead investigator Arthur Swislocki, MD, assistant chief of medical services at the VA Northern California Health Care System of Martinez and associate professor of internal medicine at the University of California-Davis School of Medicine in Davis, CA.

"This is a higher prevalence than we thought, but we need to collect more data," he added. "We do not know, for example, the difference in prevalence between these men and men in the community. We don't know the difference in smoking status between men with osteoporosis and those without."

Merck Pharmaceuticals funded the study.

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