OSTEOPOROSIS IN THE MALE - PATHOGENESIS A ND CLINICAL CLASSIFICATION IN 254 CASES

In a prospective study, 321 consecutive male patients, aged between 16 and 86 years, referred to the Department of Medicine of the Medical C entre at Leverkusen from many parts of Germany over a three-year perio d with the diagnosis of osteoporosis, under went a standardized progra mme of clinical investigation: 254 (79%) were found to have the condit ion. The programme consisted of a detailed history, physical examinati on, a battery of laboratory tests, X-ray examination of the skeleton a nd osteodensitometry. Where, as a result, underlying disease or risk f actors were suspected, further tests were performed. 98 patients (39%) were found by densitometric criteria to have preclinical, 156 (61%) m anifest osteoporosis with one or more vertebral body fractures. There was no significant difference regarding bone density between the precl inical and manifest cases. 76 of the 254 (30%) patients had no detecta ble pathogenetic factors, i. e. their osteoporosis was classified as i diopathic (mean age 51 years), while as senile osteoporosis in 16 elde rly patients (mean age 78 years). The remaining 162 patients had 286 r isk factors within 24 different categories. Depending on duration, int ensity and combination of these risk factors, the osteoporosis was cla ssified as primary with few risk factors or as secondary osteoporosis of single or multiple aetiology (mean age of these three groups was 51 , 56 and 52 years, respectively). The most important demonstrable risk factors were (in decreasing order of frequency) glucocorticoid treatm ent, alcohol consumption, smoking, hypogonadism, hypercalciuria, liver disease, Crohn's disease, low calcium nutrition, hyperthyroidism, phy sical inactivity, stomach operation and plasmacytoma. This study indic ates that if there is evidence of significant risk factors detailed bo ne densitometry should be performed so that any necessary treatment ca n be initiated early. If there is known osteoporosis, staging and exac t analysis of risk factors is a precondition for any cause-oriented tr eatment.