Osteoporosis in men

With the prolongation of life expectancy, osteoporosis has become an increasing problem in the majority of developed countries worldwide. The paper discusses the frequency, pathogenesis, diagnostic criteria and treatment options for osteoporosis in men. Every third hip fracture occurs in men, and more than 11% of the male population over the age of 50 years suffer the fracture. Diagnostic tests for idiopathic osteoporosis are performed in men under 60 years of age without other potential risk factors of developing the disease. In the majority of cases, their low bone mineral density (BMD) is caused by a low peak bone mass. Secondary osteoporosis occurs in about 30 % of men, and involutionary osteoporosis developed in men over 60 years of age results from their decreased testosterone and IGF-1 levels. The study results showing that BMD levels in both sexes provide similar fracture risk information suggest that the existing diagnostic criteria for female osteoporosis can also be employed in men. It has been proved that biphosphonate and teriparitide therapy significantly increase BMD levels in men. The administration of androgens has been shown to be effective in men with hypogonadism, although their validity for patients with eugonadism has not yet been discussed. An improved knowledge of the bone metabolism and bone remodelling has recently opened the door to an extensive series of molecules that may play a key role in the treatment of male osteoporosis in the future.     

Unexplained anaemia in men: be aware of hypogonadism

Unexplained anaemia is not uncommon. We present two male patients suffering from longstanding mild anaemia, for which no cause could be found. We performed an extensive analysis, but there were no signs of malignant disease, chronic inflammation, renal failure, hypothyroidism, myelodysplastic syndrome, haemolysis or nutritional deficiencies. However, both patients had symptoms of hypogonadism, confirmed by biochemical testing. The 56-year-old man known with metabolic syndrome turned out to have secondary hypogonadism without a pituitary tumour and the 75-year-old man had primary hypogonadism. After exclusion of prostate carcinoma, testosterone substitution therapy was started in both patients, which improved their haematocrits and sexual and general well-being substantially. Testosterone exerts anabolic effects in multiple organ systems; in bone marrow it potentiates the stimulatory effect of erythropoietin on erythropoiesis. Primary hypogonadism frequently occurs in elderly patients, while secondary hypogonadism is frequently seen in middle-aged men with type 2 diabetes mellitus and obesity.     

骨质疏松症健康信念量表的信度和效度测定

目的了解骨质疏松症住院患者对骨质疏松预防相关的危险因素、运动及摄钙基本知识的掌握,在此基础上采用因人制宜的健康教育方式,探讨健康教育对患者骨质疏松预防知识掌握的影响。方法对60例老年女性骨质疏松住院患者进行骨质疏松知识问卷调查,根据问卷调查结果有针对性对骨质疏松预防相关的危险因素、运动及摄钙知识进行宣教,比较宣教前后患者对骨质疏松预防知识认知变化情况。结果患者对骨质疏松预防危险因素知识由5.06分提高到8.20分、危险因素知识答对率由44.93%提高到74.53%;运动知识由2.68分提高到4.76分、运动知识答对率由38.30%提高到67.98%;摄钙知识由1.70分提高到4.96分、摄钙知识答对率由20.80%提高到62.00%;骨质疏松整体预防知识由9.42分提高到17.88分、骨质疏松整体预防知识答对率由34.26%提高到67.77%。差异均显著(P < 0.01)。结论老年女性骨质疏松患者对于骨质疏松预防知识认识普遍不足,经因人制宜的宣教干预后,患者对骨质疏松症危险因素认识、运动和摄钙知识水平显著提高,健康宣教对于提高骨质疏松症患者预防知识的掌握切实有效。     

Late-onset hypogonadism in men: uncertain disease entity and reservations regarding treatment with testosterone

Late-onset hypogonadism (LOH) is defined as insufficient testosterone levels in combination with associated psychological, somatovegetative and sexual symptoms in elderly men. Because the symptomatology of LOH is not specific, it is unclear whether LOH can be considered a clinically relevant entity. At this time, treatment of LOH with testosterone has been shown to have favourable effects on body composition only. The risks of treatment with testosterone appear to be minimal when absolute contraindications (prostate cancer) are observed, although long-term studies on the safety of testosterone therapy are lacking. Restraint in the diagnosis and treatment of LOH is therefore warranted.     

Human chorionic gonadotrophin raises serum immunoreactive inhibin levels in men with hypogonadotrophic hypogonadism

Inhibin is a gonadal glycoprotein hormone involved in the regulation of FSH. To elucidate the regulation of inhibin production we investigated the acute (daily for 1 week) and chronic (9-10 months of follow-up) changes in immunoreactive inhibin, testosterone, LH and FSH levels in the serum of three hypogonadotrophic hypogonadal patients treated first with hCG alone (for 3-6 months) and then hCG combined with FSH (1-5 months). One patient was unexpectedly resistant to gonadotrophin therapy; in the other two, hCG, with or without FSH, caused a rise in inhibin and testosterone, supporting previous observations that LH, as well as FSH, plays a role in the regulation of inhibin or inhibin-related peptides in men.     

Possible role of androgen receptor gene in therapeutic response of infertile men with hypogonadotropic hypogonadism

ABSTRACT

Hypogonadotropic hypogonadism (HH) is defined as a dysfunction of hypothalamic–pituitary–gonadal axis, which causes impairments in gametogenesis, pubertal maturation, and/or secretion of the gonadal sex hormones. Human chronic gonadotropin (hCG) stimulates the Leydig cells of the testis to secrete testosterone, which is essential for spermatogenesis. Testosterone replacement therapy is one of the possible options to manage HH treatment. Given the fact that testosterone functions are mediated via androgen receptor (AR), the aim of the present study was to evaluate whether the CAG/GGN triple repeat expansion in AR gene can modulate the response to hCG and testosterone treatment in HH men. Sixty-two men who diagnosed with HH and treated with testosterone and hCG were assessed after treatment. They were classified into two groups, 31 subjects with a positive and 31 subjects with a negative response to replacement therapy within 12–18 months. Androgen receptor CAG and GGN repeat numbers were measured in both groups by hot start polymerase chain reaction (PCR)-sequencing technique. Subjects who reached complete spermatogenesis showed the 20 and 23 as the median numbers of AR CAG/GGN repeats, respectively. In individuals who did not respond to treatment the median length for both CAG/GGN repeats were 23. The average of CAG repeats was statistically lower in patients who had the positive response in comparison to patients who did not respond to hormone therapy (p < 0.05), but the length of GGN repeats were not statistically different between these groups of patients (p > 0.05). The number of CAG repeats are negatively and signi?cantly associated with better hormone therapy response. Our results suggest that the length of CAG repeat polymorphism in AR gene might affect the response to treatment in men suffering from HH, whereas no relationship was found between AR gene GGN repeat polymorphism and testosterone and hCG replacement therapy response.

Abbreviations: AR: androgen receptor; FSH: follicle stimulating hormone; Gn: gonadotropins; GnRH: gonadotropin-releasing hormone; hCG: human chronic gonadotropin; HH: hypogonadotropic hypogonadism; LH: luteinizing hormone; PCR: polymerase chain reaction     

Hormonal therapy (hCG and rhFSH) for infertile men with adult-onset idiopathic hypogonadotropic hypogonadism

Abstract

Adult-onset idiopathic male hypogonadotropic hypogonadism (IMHH) is a very rare but treatable disease. This study was conducted to examine the efficacy and safety of a combination of human chorionic gonadotropin (hCG) and recombinant human follicle-stimulating hormone (rhFSH) for inducing spermatogenesis in men with adult-onset IMHH. Seven men (34–45 years of age) with azoospermia and/or sexual dysfunction, with a low serum testosterone concentration, and apulsatile secretion of luteinizing hormone, were referred to our hospital for infertility. All had normal secondary sexual characteristics. Thorough endocrinologic examination and magnetic resonance imaging revealed no identifiable cause of hypogonadotropic hypogonadism. Adult-onset IMHH was diagnosed in all cases and treatment was started with 150?IU rhFSH and 5,000?IU hCG, both administered two times per week. Spermatogenesis was restored in five of the seven patients. During treatment one patient achieved spontaneous pregnancy with his wife, and spermatozoa recovered from the other four patients were frozen for future use in intracytoplasmic sperm injection.     

Health Beliefs about Osteoporosis and Osteoporosis Screening in Older Women and Men

OBJECTIVE: To examine older adults' beliefs about osteoporosis and osteoporosis screening to identify barriers to screening. DESIGN: Cross-sectional mailed survey. SETTING: Western Pennsylvania. METHODS: Surveys were mailed to 1830 women and men aged 60 years and older. The survey assessed sociodemographic characteristics, osteoporosis and general health-related characteristics, and beliefs about osteoporosis severity, susceptibility, screening self-efficacy, and screening response efficacy. Analyses included Wilcoxon rank-sum tests to compare belief dimension scores, and multivariable ordinal logistic regression analyses to evaluate association between osteoporosis beliefs and potential explanatory variables. RESULTS: Surveys were completed by 1268 individuals (69.3 per cent). Mean age of respondents was 73.3 years, and most were female (58.7 per cent). Individuals demonstrated greatest belief in the severity of osteoporosis and least belief in personal susceptibility (P <.001). Older individuals believed less strongly than younger individuals in osteoporosis severity (OR, 0.95 per 1-year increase in age; 95 per cent CI, 0.92-0.97) and response efficacy (OR, 0.97 per 1-year increase in age; 95 per cent CI, 0.95-0.99). Women believed more strongly than men in osteoporosis susceptibility (OR, 1.87; 95 per cent CI, 1.38-2.53) and screening self-efficacy (OR, 2.87; 95 per cent CI, 1.17-7.07). Individuals with high self-rated health status had greater belief than those with low self-rated health status in screening self-efficacy (OR, 3.59; 95 per cent CI, 1.89-6.83). CONCLUSION: Older adults demonstrate several beliefs that may be barriers to osteoporosis screening, including low belief in susceptibility to osteoporosis. These beliefs should be targeted with patient education to improve screening rates.     

Osteoporosis and Inflammation

Osteoporosis represents a major healthcare burden, affecting approximately 10 million people aged over 50 years in the United States and with another 30 million or more at risk. One of the major contributing factors to osteoporosis is withdrawal of estrogen during menopause in women. Human and animal experiments have implicated pro-inflammatory cy-tokines as primary mediators of the accelerated bone loss at menopause including interleukin-1, tumor necrosis factor-α, and interleukin-6. Increased production of pro-inflammatory cytokines is associated with osteoclastic bone resorption in a number of disease states including rheumatoid arthritis, periodontitis, and multiple myeloma; estrogen withdrawal is associated with increased production of pro-inflammatory cytokines, and exposure of bone cultures to supernatants from activated leukocytes is associated with increased bone resorption. A major advance has been the discovery ofRANKL, its receptor RANK, and the endogenous inhibitor osteoprotegerin. The binding of RANKL to RANK is essential for the differentiation and activation of osteoclasts and mediates the actions of essentially all known stimulators of osteoclastic bone resorption. RANKL expression is heightened in post- compared with pre-menopausal women, and this effect is attenuated by estrogen replacement therapy. RANKL is also a therapeutic target; a human antibody with high specificity and affinity to RANKL is currently under clinical evaluation for the treatment of osteoporosis in post-menopausal women and of metastatic bone disease in cancer patients with bone metastasis. Early data are promising.     

骨质疏松症的现状、流行趋势与研究方向

目的了解上海市部分社区居民的骨质疏松知识认知、骨质疏松预防自我效能和自我管理行为状况及社区宣传干预的效果。方法在上海市20个骨质疏松诊疗管理规范试点社区开展骨质疏松危险因素、防治知识、管理行为等的宣教,宣教前后分别采用方便抽样的方法抽取2 000名居民进行问卷调查,评估宣教干预效果。结果干预后社区居民骨质疏松危险因素知识、运动知识和钙知识的平均正确率较干预前分别提升了20.7%,20.4%和14.5%(P＜0.01)。干预后社区居民的骨质疏松运动效能和摄钙效能,社区居民骨质疏松预防饮食行为、生活方式和运动行为也较干预前显著提升(P＜0.05)。结论经规范化管理和宣教干预后,社区居民对骨质疏松症认知、效能和管理水平显著提高,骨质疏松症规范化管理宣教干预切实有效。     

Socioeconomic status and quality of life in population‐based Australian men: data from the Geelong Osteoporosis Study

Objective : To investigate the relationship between socioeconomic status (SES) and reported perceptions of quality of life (QOL) in a cross‐sectional population‐based analysis of a representative sample of Australian men. Methods : In 917 randomly recruited men aged 24–92 years, we measured QoL in the domains of physical health, psychological health, environment and social relationships, using the Australian World Health Organization Quality of Life Instrument (WHOQOL‐BREF). Residential addresses were cross‐referenced with Australian Bureau of Statistics 2006 census data to ascertain SES. Participants were categorised into lower, mid, or upper SES based on the Index of Relative Socioeconomic Disadvantage and Advantage (IRSAD), the Index of Economic Resources (IER), and the Index of Education and Occupation (IEO). Lifestyle and health information was self‐reported. Results : Males of lower SES reported poorer satisfaction with physical health (OR=0.6, 95%CI 0.4–0.9, p=0.02), psychological health (OR=0.4, 95%CI 0.3–0.7, p<0.001) and environment (OR=0.5, 95%CI 0.3–0.7, p<0.001), although not social relationships (p=0.59). The poorest QOL for each domain was observed in the lower and upper SES groups, representing an inverse U‐shaped pattern of association; however, statistical significance was only observed for psychological health (OR=0.5, 95%CI 0.4–0.7, p<0.001). These relationships were similar for IEO and IER. Conclusions : Men from lower and upper SES groups have lower QOL compared to their counterparts in the mid SES group.     

锶与骨质疏松症

骨质疏松是以骨密度、强度下降,脆性增加以及易于发生骨折为主要症状的一种全身性骨胳疾病。大量的研究表明,锶元素对体内骨骼中代谢有显著影响,锶既可抑制骨吸收,又可促进骨形成的作用。因此,锶盐具有抗骨吸收和增进骨形成双重作用,代表了在骨质疏松症治疗上一个新的重要发展方向。针对锶对骨代谢的影响进行综述。