BONE-DENSITY AND FRACTURE RISK IN MEN

We evaluated different definitions of osteoporosis in a population-bas ed sample of 348 men (age 22-90 years) compared with 351 women (age 21 -93 years)Thirty-six men (10%) and 46 women (13%) had a history of ost eoporotic fracture (hip, spine, or distal forearm due to moderate trau ma at greater than or equal to age 35). In logistic regression analysi s, osteoporotic fracture risk was associated with bone mineral density (BMD) at all sites (neck, trochanter, total hip, lumbar spine, and to tal wrist) in both genders (p < 0.001.) except spinal BMD in men. Afte r adjusting for age, total hip BMD was the strongest predictor of frac ture risk in women (odds ratio [OR] per 1 SD decline, 2.4; 95% confide nce interval [CI], 1.6-3.7), while wrist BMD was best in men (OR, 1.5; 95% CI, 1.1-2.0). Among men but not women, bone mineral apparent dens ity (BMAD) was a better predictor of fracture than BMD (wrist BMAD OR, 1.7; 95% CI, 1.3-2.3). Hip BMD/BMAD decreased linearly from age 20 ye ars onward in both genders, while spinal BMD/BMAD declined after age 4 0 in women but not in men. In both genders, total wrist BMD/BMAD decre ased after age 50. By World Health Organization criteria, the age-adju sted prevalence of osteoporosis at the hip, spine, or wrist was 35% am ong women greater than or equal to 50 years of age. A similar approach (BMD > 2.5 SD below the young male mean) produced an osteoporosis pre valence rate in men greater than or equal to 50 years of age of 19%. T hus, bone density predicts fracture risk in men as it does in women, a nd the prevalence of osteoporosis in men, using sex-specific normal va lues, is substantial. These observations indicate a need for better pr evention and treatment strategies for men.