Male Hypogonadism And Osteoporosis: A Systematic Review

Abstract

Background: Male hypogonadism can be defined as a disorder caused by decreased testosterone levels leading to low sperm count, multiorgan dysfunction and inadequate quality of life. Osteoporosis is defined as a debilitating condition which causes loss of bone mass and structure leading to considerable risk of fragility fracture and increased mortality. About 6% of men and 21% women between ages 50 to 84 years suffer from osteoporosis, changing the lives of 27.6 million males and females in the European Union (EU) in 2010. Osteoporosis is responsible for>8.9 million fractures yearly around the world, about 1000 cases an hour. The prevalence of osteoporosis increases as the population advances in age. Fracture risk increases in those with reduced bone mineral density(BMD) than those with osteoporosis.Although the risk of osteoporotic fracture is less in men than women however men are twice at risk of dying from the consequences of such fractures than women. World Health Organization (WHO) defined osteoporosis as a BMD of 2.5 standard deviation (SD) or more below the mean in young healthy female, with a T score of-2.5 or lower. The American college of physicians recommend early evaluation of men<65 years old who are at high risk of osteoporosis using Dual energy x-ray absorptiometry (DXA) scan. Objective: The aim of this review is to conduct a systematic review of available literature to evaluate epidemiology and risk factors for osteoporosis in men. The focus of this work was to critically review evidence related to impact of hypogonadism on bone health in men. Methods: A thorough search of different electronic databases was done including PubMed, google scholar, Cochrane database and FINDIT in the university of South Wales library and data collected. Results: Some studies reported that only 4.5% men were treated for osteoporosis compared to 27% women. The annual death rate was 32% in men and 17% in women. In 1-5 years follow up, only 27% men were on any form of therapy while 71% women were on treatment. A study of 241 men who received 10mg of alendronate daily for 2 years compared to placebo showed a notable rise in BMD, and a notable decrease in fracture of the vertebra was documented with OR of 0.10, CI; 95%; 0.00-0.88. A study of 284 men treated with risedronate showed successful increase in BMD in contrast to placebo. Obesity is one of the most common causes of male hypogonadism, usually associated with normal or reduced follicle stimulating hormone (FSH), luteinizing hormone (LH) and low testosterone levels. Conclusion: The burden of osteoporosis is severe and is shown in the increased level of disability and death in the affected patients and yet only a small number of men are given adequate treatment. Recognition and treatment of male hypogonadism and osteoporosis has received some attention lately, however, it remains under detected and under treated, much needs to be done in investigating for hypogonadism in men with fragility fractures.