Sampled reviewed Licata, A. (2003, March). Osteoporosis in men ; Suspect secondary disease first.

Retrieved October 14th, 2013, from Cleveland Clinic Journal of Medical: www.ccjm.org The Osteoporosis is a common disease that is attacking many elderly people nowadays resulting to the bones becoming fragile or more likely to have thinning bones. Usually, in this osteoporosis cases, the bone loses density as it measures less amount of calcium and minerals in the bones. Osteoporosis is a certain state of bone condition that affects the bones and causing them to become weak and more fragile and possibilities to break or fracture. The fractures can most commonly occur in the spine area, the wrist and hips. However, it can affect the other part of bones such as the arm and pelvis. Nowadays, there are many cases of osteoporosis and also there are many products selling items that contain more calcium to help people in preventing them from getting osteoporosis. However, most cases are likely to be discussing about osteoporosis in women and their symptoms and the impacts of it. The male cases are less to be discussed and more likely less to be analysed. However, in the article entitled, Osteoporosis in men; Suspect Secondary Disease First written by Angelo Licata retrieved from www.ccjm.org on 14th October 2013, there is a clear discussion about the osteoporosis in men. The author in this article shows, a great concern about the osteoporosis in men as the osteoporosis in men are more secondary than the women and the treatments are more likely similar to the women due to the limited data about the osteoporosis in men. In this article, Licata discusses a few main points such as prevention is seen as a better approach to the treatment due to the limited methods of the other treatments. The top list of drugs that causes osteoporosis is also being discussed here and also the bone density in men compared to women. In addition to that, the discussion was furthered to the comparison of the biochemical evaluation in older and younger male. In

addition to that, the discussion was also done in comparison of the skeletal density between men and women and their bone structures. Licata also discussed about the hormones in the bone structures and the risks on the fractures. According to Licata, the osteoporosis is not a disease only for women but also for men as men account for 20% of cases of osteoporosis and 25% of hip fractures (page 247). In addition to that, the consequences are worse to men than for women (page 247). The author proved the statement by adding the fact that the men with hip fractures have higher rates of mortality and morbidity. Licata also mentioned that the osteoporosis in men are more secondary, while in women are more primary (idiopathic). Even though there are many awareness about osteoporosis walking together with the advances technologies, the awareness about the osteoporosis in men are still lacking. Thus, the author has outlined clearly the unique features of osteoporosis in men on the physiology, causes, diagnosis, and treatments. According to Licata, the osteoporosis in the men and women differs according to the age. Licata provided a graph to show the difference between men and women to see when mostly they have this osteoporosis. Based on the bar graph, distribution of women in osteoporosis happens later in ageing, whereby usually after the age of 50. However, among the men, it happens early, usually before the age of 50 and slowly decreases after that. The author also discussed the reason of why there are fewer men having osteoporosis and the reason is because they have a lower prevalence than women. The reason is because men accumulate more bone mass during the peak years and thus this make their bones stronger compared to women. In addition to that, they accumulate more muscle mass and it provides skeletal strength. Another reason discussed is because men do not undergo menopause and their testosterone level declines slowly preventing hormone changes in abrupt. Next reason is because the life spans of men are shorter compared to women. Therefore, primary

osteoporosis has less time to develop compared to women. The last reason discussed by Licata is the ascertainment bias whereby fewer men undergo the bone density measurement that leads to the incorrect data that men have fewer risk towards the osteoporosis. The author discussed on why the primary osteoporosis may be different in men. The reason is because it is usually described referred to aging. The basic believe is because the osteoporosis in men results from trabecular thinning rather than from trabecular destruction as seen in women (page 248). In addition to that, the combination of the metabolic variation and the changes of endocrine contribute in weakening the skeleton. The production of testosterone and growth hormone decrease also leads to the muscles deterioration. The discussion later goes on about the causes of secondary osteoporosis. Licata wrote that many diseases and drugs can lead to osteoporosis. There are certain drugs that can induced the bone loss and the top list of drugs that can cause osteoporosis is the glucocorticoids. This is because it has systemic effects on the skeleton as the excessive doses of glucocorticoids have many bad effects on calcium and bone metabolism (page 248). Thus the drug attacks the skeletal integrity as it absorbs the intestinal calcium directly. However, according to Licata in this article, there are many other drugs that lead to osteoporosis other than glucocorticoids. The drugs are anticonvulsants that enhance the vitamin D metabolism which causes calcium malabsorption, antigonadotropic drugs that are used in treating prostate cancercan cause osteopenia (the fractures in bones) and lastly the usage of tobacco and alcohol that flows direct toxic to the skeleton. Gastrointestinal disease such as the ulcers, inflammatory bowel disease, pancreatic insufficiency, and malabsorptive problems can cause osteoporosis. Another disease is the hypercalcuria or the renal tubular either with or without stone disease and almost 20% of men in osteoporosis (page 249) is found with this disease. In addition to that, Licata mentions that patients with latent calciuria have normal calcium excretion because of their

low intake of calcium. Other than that, endocrine disorder is another well-known disorder that causes osteoporosis. The hypogonadism which is during the puberty can cause the adult skeletal deficiency during their peak development of bone mass. Next is the hyperparathyroidism that causes the bone destructions. However, more than 80% of patients with hyperparathyroidism have no symptoms (page 250). Another disorder is the endogeneous hypercortisolism than can cause fractures and leads to osteoporosis. Hyperprolactinemia is also another disorder because it can decreases testosterone production and libido and leads to osteoporosis. Primary hyperthyroidism can also be a cause of osteoporosis but then usually it is diagnosed long before it can destroy the skeleton. Lastly, is the acromegaly as it can lead to the osteoporosis paradoxically as it leads to the growth of tumour. In addition to that, Licata also explains about the other causes to osteoporosis. The causes are plasma cell dyscrasias, multiple myeloma and even benign monoclonal gammopathy that can increase bone turnover. Next is the leukemia that can be associated seriously to the chronic bone destruction. Other disorder is such as the benign hematologic like thalassemia and vitamin B. Malignant disorder is like the humoral hypercalcemia as it portends a short prognosis. The last reason can be because of the genetic or metabolic disorder that can cause osteoporosis. A family history of having this genetic can cause osteoporosis. As for the diagnosis, the bone densitometry and the T scores has made a great awareness together with the advances technologies nowadays. The author explained that in order to detect early osteoporosis in the women and men, the dual energy x-ray absorptiometry is used. Licata believes that the bone density evaluation should be mandatory for men after age 60 or 65 if there is no specific history of unexplained fracture (page 251). Thus, if this can be done, the usage of the data and information can be useful for

both men and women in identifying the problems in osteoporosis and in seeking the right treatments for it. As for the T score, the usage of the caveat can be used to determine the risk of the fractures in both women and men by collecting certain data. The T scores are very useful because the age distribution of men and women of getting osteoporosis is different. Thus, if a female data base is used, only 3% to 5% of men have osteoporosis, whereas 30% of me over age 50 have osteoporosis (page 251). Therefore, the author suggests that it should be a must for all men to diagnosis for osteoporosis to get an accurate data about the osteoporosis. However, using T scores should not be the only guideline to detect osteoporosis. According to the author, the treatments should not be stopped until the patients T score reaches a specific level so that it can be used in assisting treatments. However, it is important to treat and diagnosis the treatments clinically. This is because the T scores cannot really diagnose osteoporosis on the basis of the personal and family history and other values. There is a clinical and laboratory diagnosis of osteoporosis in men that can consider the primary osteoporosis. The author also explains that we should not assume that all osteoporosis in women are primary because there is a risk of being secondary causes in osteoporosis too. As for the history and physical examination in most men, the history can cause the raises of great suspicion like the family history or other genetic problems. Thus, an appropriate laboratory usage and the radioactive are needed for further diagnosis. According to Licata, the family history of osteoporosis is very important either in men or women. This is because if there is an osteoporosis in family members, it can predict the bone density for their children. Licata discussed that the physical examination reveals the cushingoid features, acromegaly, or hypogonadism, or evidence of blood dycrasias or cancer, liver disease, or pathognomonic skeletal abnormalities (page 252).

Licata furthered the discussion about the laboratory testing that is more extensive in men. Due to the secondary conditions of bone loss in men, the biochemical evaluation tends to be more extensive in men. Licata also discussed that the younger the male patient is, the more important the laboratory evaluation is (page 252). The reasons for the biochemical is because the routine check up of the biochemical profiles and complete blood cell can reveal the suspicious findings that can lead to further abnormalities that can be evaluated to better findings on osteoporosis. In addition to that, due to the common hypercalciuria, routine urine testing for 24-hour excretion of calcium is initialled because it can lead to suspicion of bone disease. Other than that, on the rare cases, the evaluation of hypophosohatasia,

homocystinuria or osteogenesis will be sufficient to check the low serum alkaline phosphatise. This can be done together with the checkups on the physical features and history of fractures to get a better accurate result. The author also suggested skeletal biopsy if there is no abnormality found on the laboratory testing and there is no clue of where the findings are leading. Despite of the suggestion, Licata mentioned that in their clinic experience, biopsy has not proven as helpful as laboratory or clinic data. (page 252). However, there is no harm in trying all possible ways in order to ensure in getting good data to analyse for better findings. In treating the secondary osteoporosis in men, the author discussed about how it actually implies towards men and the way to diagnose it. The main factor in treating the secondary osteoporosis is by seeking the underlying causes of it as the cause is controlled or eliminated depending on the degree of bone damage (page 252). In order to vary the degrees of bone loss, treatments that can be used are like hypercortisolism, hyperparathyroidism, acromegaly, or hyperprolactinemia. In addition to that, the best treatment of skeletal disease due to intestinal or drug induced malabsorption that usually responds well to calcium and vitamin D supplementation. In theory, the drug related bone loss should respond by stopping

the drug. However, Licata suggested two types of drugs that should be prescribed prophylactically when cronic steroid treatment is started. The drugs are bisphosponates alendronate (Fosamax) and risedronate (Actonel). In addition to that, the usage of Thiazide diuretics can stop renal calcium loss and reverse skeletal deficiency to varying degrees (page 252). The author then indicated on how to treat idiopathic osteoporosis in men. The discussion was that the recent approval of alendronate for use in men is the starting point where the idiopathic osteoporosis in men is being treated. First step is by using the

nonpharmacologic measurements. However, this measurement is said not to be sufficient for men without the involvement of calcium and vitamin D supplementation added with exercise. In addition to that, the healthy lifestyle with smoking cessation and limited use of alcohol is as important in men as it is in women. (page 253). Another step is by using the hormonal theraphy. In this hormonal therapy the testosterone therapy is marginally effective in the hypogonadism of aging but is more effective in hypogonadism of younger men. In addition to that, the usage of sodium fluoride is also being discussed whereby this sodium fluoride has long been used in women as an osteoblastic stimulator and even though men is yet to be fully evaluated, there are still limited studies about it. Among the women, the excessive doses produce dense and poor quality bone that is prone to fracture. As for the usage of bisphosphonates, the first drug used is alendronate in order to show efficacy in men and in increasing the skeletal density compared to women. Etidronate is a drug used in women and therefore theoretically should help men too and thus the risedronate should also be beneficial. As a conclusion, the author clearly discussed and explained about the osteoporosis among the men and the comparison to the women. It is common for everyone to understand

how osteoporosis is actually being a silent disease among many elderly people. However, many did not notice that osteoporosis among the men is actually attacking them in an earlier stage. This is a piece of information that many people is not aware of. Thus, the osteoporosis among the women and men is not the same and the concept will be different. In addition to that, the authors also outlined the proper points such as the pathopsyiology, causes, diagnosis and treatment. Other than that, the author also briefly explained that the osteoporosis in men is secondary and more primary like in women. I find this article to be very useful and informative since most articles either discuss about osteoporosis in general or in women. Therefore, this article is definitely very useful for male readers as it will give them an idea about being precautious about osteoporosis. The author explains about the disorders and diseases that may lead to osteoporosis and the other causes and reasons in general and specifically. Licata also explains clearly and deeply about the drugs used for the treatments and other therapies that will be useful to diagnose the osteoporosis. In conclusion, the reading on this osteoporosis will definitely be useful to not only me but also all readers either men or women in expanding their knowledge about osteoporosis. The knowledge will be useful as a precaution for us and also as a therapy for either us or for someone that we know. Thus, the article Osteoporosis in men; Suspect Secondary Disease First written by Angelo Licata is definitely an article that is not only informative but also very useful.