What is the significance of gender as predictor of osteoporosis

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Download references. There was no external funding. You can also search for this author in PubMed Google Scholar. All authors read and approved the final manuscript. Correspondence to Robert Wen-Wei Hsu. The study protocol was also registered in the ClinicalTrails.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. After the menopause , oestrogen levels fall. This can lead to a rapid decrease in bone density. In most cases, the cause of osteoporosis in men is unknown. However, there's a link to the male hormone testosterone, which helps keep the bones healthy. Men continue producing testosterone into old age, but the risk of osteoporosis is increased in men with low levels of testosterone.

In around half of men, the exact cause of low testosterone levels is unknown, but known causes include:. Journal of Bone and Mineral Research, 11 12 , Meier, C. Archives of Internal Medicine, , Journal of Bone Mineral Research, 23 , Melton, L.

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Geneva, Switzerland. Wu, X. Calcified Tissue International, 73 , Osteoporosis has long been defined as a disease primarily of post-menopausal women—an assumption that has shaped its screening, diagnosis, and treatment.

Why is this a problem? Men account for a third of osteoporosis-related hip fractures after age 75—and when they break their hips, they die more often than women. We don't know why. Despite the relatively high number of men who suffer from osteoporosis, the basic diagnostics for the disease were developed using young, white women aged years.

The breakthrough came in when a reference population of young men was established to diagnose osteoporosis in men.

Although we now have reference populations for men, men are still diagnosed using the female diagnostic cut-off rate—this has not yet been revised for men. Work continues to diagnose osteoporosis in different populations of women and men. Osteoporosis is a disease with both sex and gender components: bones are formed by biology and also by culture, such as exercise rates, nutrition, and general lifestyle.

These differences in lifestyle may explain differences in osteoporosis rates across ethnic groups. Current studies are analyzing cohorts of men from China and Sweden, for example, to understand these types of differences. The goal is to maintain healthy bones in diverse populations. What is Gendered Innovations?

Method: Rethinking Standards and Reference Models Research in many fields—for example, heart disease—has relied on reference models that treat men as the norm. Gendered Innovations: Establishing Male Reference Populations By , evaluation of men's bone quality was based on BMD norms of healthy young men rather than healthy young women Looker, More work needs to be done to redefine diagnostic cutoffs for both women and men Binkley et al.

However, in the clinical practice these reccomandations seems to be still disregarded. Despite the increased attention of research, the still low sensitivity of the population to this problem, in many situations limits the access of males to services for the diagnosis of osteoporosis with insufficient prevention of osteoporotic fractures in men.

The aim of our study was therefore to identify any gender disparities in osteoporosis screening in a routinely clinical setting. For this purpose, we assessed gender differences in BMD, bone remodeling serum markers and fractures in subjects observed in the last 3 years at the Outpatient Service for the Diagnosis of Osteoporosis at Teramo Hospital. To assess gender disparities in osteoporosis in the clinical practice, we observed people consecutively admitted at our Outpatient Service for the Diagnosis of Osteoporosis during the last 3 years.

Patients referred to our medical center for known osteoporosis or osteopenia and already taking anti-osteoporotic therapies were excluded. All DXA evaluations were performed by the same certified radiologist. The fracture risk assessment FRAX score, supported by the WHO for estimating the year probability of hip and other major osteoporotic fractures [ 20 ] was also determined for each subject, based on the clinical and anamnestic data obtained from patient records.

Moreover, data obtained from laboratory exams carried out at the time of the visit, including and bone turnover serum markers, were considered. All clinical, laboratory and instrumental findings were collected in a Microsoft Excel spreadsheet for subsequent processing.

Informed consent was submitted by all subjects when they were enrolled. Out of a total of 3, patients admitted to the Outpatient Service for Osteoporosis over the last 3 years, 2, subjects mean age Click for larger image Download as PowerPoint slide. Eighty-nine percent of women had reduced BMD osteopenia and osteoporosis vs.

Therefore, in people undergoing screening, women are more likely to experience reduced bone density Fig. The proportions of fractured and unfractured men and women are compared in Fig. A total of Therefore, although the higher T score values in men, the proportions of fracture events were quite similar. Stratifying patients according to BMD, Mean values of FRAX score for major osteoporotic fractures were globally higher in women compared with men Bone turnover serum markers have been evaluated in both genders and data from total women and men screened populations, as well as normal osteopenic and osteoporotic subjects, stratified according to gender, are shown in Table 1.

Table 1 Serum markers of bone turnover in women and men Click for larger image Click for full table Download as Excel file. Out of 2, women and men who underwent osteoporosis screening for the first time, 1, women Frequencies of the various pathologies and drugs in men and women are shown in Table 2.

Finally, Fig. Twenty four out of 36 osteoporotic men This study is not intended to be an epidemiological evaluation of the prevalence of osteoporosis in men and women in our region. Its purpose is rather to highlight a still marked gender bias in the clinical management of osteoporosis which penalizes men.

Osteoporosis is one of the most emblematic gender pathologies, both as regards prevalence and for the various causes that underlie men and women osteoporosis.

Prevalence rates of osteoporosis and osteopenia are higher in women than in men, and, in both genders, the rates of osteoporosis increases significantly with age. As for the causes, postmenopausal osteoporosis is the most common form of osteoporosis in women, while secondary and senile forms prevail in men. The fact that osteoporosis is a much more common disease in women than men, has led researchers and clinicians to focus most studies and treatments on women osteoporosis.

As a consequence, most of the diagnostic algorithms are designed for women osteoporosis. Furthermore the women population, especially in the peri- and post-menopausal age, is more aware of the problem and therefore undergoes screenings and therapies. Unfortunately, both practitioners and patients are not sufficiently attentive to men osteoporosis.

There are no specific indications for men osteoporosis screening programs. Men with osteoporosis are therefore underdiagnosed as they rarely undergo diagnostic tests for osteoporosis. Our 3-year observational study highlights precisely this socio-sanitary gender bias that penalizes men in daily practice, especially as regards access to diagnostic tests for osteoporosis, such as bone densitometry.

Despite numerous elderly men may therefore incur serious osteoporotic fractures, especially femoral fractures, men osteoporosis still remains largely undiagnosed and consequently not treated. To overcome this cultural gender bias it is necessary to sensitize the population and promote access to screenings also for men. We in fact highlighted how men are much less often screened for osteoporosis than women of the same age.

Moreover, we observed a higher prevalence of secondary osteoporosis in men Our experience therefore confirms that the prevalence of osteoporosis secondary to underlying pathologies and drugs is more common in men than in women, in whom postmenopausal and senile osteoporosis are mainly represented. Screenings for osteoporosis could therefore represent a useful tool for early diagnosis and treatment of underlying diseases as well [ 19 , 20 , 21 , 22 , 23 , 24 , 25 ].

Similar results were previously described in a retrospective study on a total of DXA scan reports reviewed at the outpatient clinic of the George Washington University in the [ 26 ], where the authors observed that males were screened for osteoporosis by DXA less frequently compared to females, although they exhibited a comparable osteoporosis prevalence. They included in their study only subjects with previous routine health maintenance exam to assure that their primary care physician have had the opportunity to sensitize them on the most suitable age to undergo screening for osteoporosis by DXA, concluding that an adequate information could increase the percentage of males who undergo the DXA scan screening.

Data from our screened subjects also confirm that although older women tend to get sicker and take more therapies, secondary osteoporosis is much more frequent in men.

Moreover, although our results indicate a greater risk for major osteoporotic fractures distal radius, hip, or vertebral in women, men suffering from osteoporosis and osteopenia appear to have a higher risk of hip fractures than women with comparable BMD values.

These findings suggest a greater severity of osteoporosis in men, since femoral fractures are the most disabling and life threatening. DXA therefore continues to be underutilized as a screening tool in males, where the diagnosis of osteoporosis is often not made until a fracture occurs, most often in the femur. On the contrary, in women there is a greater chance that the diagnosis of osteoporosis will be made in an early stage by DXA scan before a fracture [ 27 ].

Additionally, it has been found that men are not only usually under-screened for osteoporosis, but are also often under-treated, even if they are users of long-term corticosteroids [ 28 ].