Fractures In Men Research Articles

Barriers to Care of Sexual Health Concerns in Men Following Traumatic Pelvic Fractures

IntroductionTraumatic pelvic fractures are associated with sexual dysfunction in men. However, how men are counseled and access care for sexual health following injury remains unknown. AimThe purpose of this study was to identify factors associated with accessing and obtaining care for sexual health concerns following traumatic pelvic fracture in men. MethodsMen treated for traumatic pelvic fractures at a level 1 trauma center were invited to participate in an online cross-sectional survey. The survey addressed multiple demographic and sexual function domains, as well as the postinjury sexual health care experience. De novo sexual dysfunction following injury was ascertained and reasons for not seeking care examined. Inverse probability weighting was utilized to adjust for nonresponse. Multivariable logistic regression was performed to identify factors associated with discussion of sexual health with providers after injury. OutcomesThe primary outcome was discussion of sexual health with health care providers after injury. Secondary outcomes included prevalence of self-reported sexual dysfunction, classification of sexual dysfunction experienced, and perceived barriers to accessing or obtaining care for sexual health concerns. Results277 men completed the survey. After adjustment, 46.3% (95% CI = 39.4%–53.0%) reported de novo sexual dysfunction after injury, with erectile dysfunction the most common symptom (27.9%). Only 20.4% (95% CI = 15.1%–26.0%) recalled having discussions or being asked about their sexual health following injury, and of these conversations 70.7% were patient-initiated. The most common perceived barriers to discussing sexual health with providers were the belief that sexual dysfunction would resolve with time (26.1%), and a lack of knowledge about their condition and treatment options (21.5%). On multivariate analysis, the presence of postinjury sexual dysfunction (adjusted odds ratio [aOR] = 3.42), private insurance (aOR = 2.17), and being married or in a partnership (aOR = 3.10) were independently associated with likelihood of having had sexual health discussions. Clinical ImplicationsDespite the high prevalence of sexual dysfunction in men following pelvic trauma, sexual health concerns are inadequately addressed due to both patient and provider factors. Strengths & LimitationsThe major strengths include large sample size, detailed reporting of subject experience, and new information in a previously understudied area of pelvic trauma survivorship. The primary limitations are low survey response rate, lack of representativeness of survey participants to whole pelvic fracture cohort, single-center experience, and cross-sectional study design. ConclusionSexual health concerns after pelvic fracture are common but inadequately addressed by health care providers. Improved postinjury, survivorship-model care pathways need to be designed to better address sexual health after injury.Johnsen NV, Lang J, Wessells H, et al. Barriers to Care of Sexual Health Concerns in Men Following Traumatic Pelvic Fractures. J Sex Med 2019;16:1557–1566.

Associations Between Bone Impact Microindentation and Clinical Risk Factors for Fracture.

Impact microindentation (IMI) measures bone material strength index (BMSi) in vivo. However, clinical risk factors that affect BMSi are largely unknown. This study investigated associations between BMSi and clinical risk factors for fracture in men. BMSi was measured using the OsteoProbe in 357 men (ages 33 to 96 years) from the Geelong Osteoporosis Study. Risk factors included age, weight, height, body mass index (BMI), femoral neck bone mineral density (BMD), parental hip fracture, prior fracture, type 2 diabetes mellitus (T2DM), secondary osteoporosis, smoking, alcohol consumption, sedentary lifestyle, medications, diseases, and low serum vitamin D levels. BMSi was negatively associated with age (r = -0.131, P = 0.014), weight (r = -0.109, P = 0.040), and BMI (r = -0.083, P = 0.001); no correlations were detected with BMD (r = 0.000, P = 0.998) or height (r = 0.087, P = 0.10). Mean BMSi values for men with and without prior fracture were 80.2 ± 6.9 vs 82.8 ± 6.1 (P = 0.024); parental hip fracture, 80.1 ± 6.1 vs 82.8 ± 6.9 (P = 0.029); and T2DM, 80.3 ± 8.5 vs 82.9 ± 6.6 (P = 0.059). BMSi did not differ in the presence vs absence of other risk factors. In multivariable models, mean (± SD) BMSi remained associated with prior fracture and parental hip fracture after adjusting for age and BMI: prior fracture (80.5 ± 1.1 vs 82.8 ± 0.4, P = 0.044); parental fracture (79.9 ± 1.2 vs 82.9 ± 0.4, P = 0.015). No other confounders were identified. We conclude that in men, BMSi discriminates prior fracture and parental hip fracture, which are both known to increase the risk for incident fracture. These findings suggest that IMI may be useful for identifying men who have an increased risk for fracture.

Exercise for improving outcomes after osteoporotic vertebral fracture.

Exercise for improving outcomes after osteoporotic vertebral fracture.

Annals for Educators - 2 July 2019.

Annals for Educators - 2 July 2019.

Proteinuria Is Associated With Increased Risk of Fragility Fracture in Men With or at Risk of HIV Infection.

Proteinuria has been associated with bone loss and fractures in general population, but data in HIV-infected population are lacking. Prospective, multicenter cohort study of men with or at risk of HIV infection. Between 2006 and 2015, urine protein measurements and bone fracture histories were ascertained semiannually in 947 HIV-infected (HIV+) and 969 HIV-uninfected (HIV-) men aged 40 years or older. Proteinuria was defined as protein-to-creatinine ratio ≥200 mg/g at ≥2 consecutive visits. Outcome measures (1) all fractures (excluding fractures of skull, face, and digits) and (2) fragility fractures (fractures of vertebral column, femur, wrist, and humerus). Multivariable Cox proportional hazards models assessed the association between proteinuria and fracture after adjusting for additional risk factors. The overall period prevalence of proteinuria was higher among HIV+ than HIV- (29% vs 6%, P < 0.001). Men with proteinuria had a significantly higher risk of fragility fracture compared with men without proteinuria [adjusted hazard ratio (aHR) = 2.29 (1.12-4.66)] and did not differ by HIV serostatus (p-interaction = 0.83). The risk of all fractures was not statistically different between men with or without proteinuria [aHR = 1.31 (0.84-2.05)]. Among HIV+ men, the association between confirmed proteinuria and fragility fracture was attenuated [aHR = 2.12 (0.95-4.73)] after additional adjustment for CD4 T-cell count/mm, history of AIDS, the presence of detectable plasma HIV-1 RNA, and cumulative exposure to tenofovir disoproxil fumarate. Proteinuria was more common in HIV+ than in HIV- men and was a strong independent risk factor for fragility fracture regardless of HIV serostatus. Proteinuria should prompt consideration of a thorough evaluation for bone disease among HIV+ persons.

Dietary Intake, D3Cr Muscle Mass, and Appendicular Lean Mass in a Cohort of Older Men.

We examined cross-sectional associations between dietary patterns, macronutrient intake, and measures of muscle mass and lean mass in older men. Participants in the Osteoporotic Fractures in Men (MrOS) cohort (n = 903; mean ± SD age 84.2 ± 4 years) completed brief Block food frequency questionnaires (May 2014-May 2016); factor analysis was used to derive dietary patterns. The D3-creatine (D3Cr) dilution method was used to measure muscle mass; dual-energy x-ray absorptiometry (DXA) was used to measure appendicular lean mass (ALM). Generalized linear models were used to report adjusted means of outcomes by dietary pattern. Multiple linear regression models were used to determine associations between macronutrients and D3Cr muscle mass and DXA ALM. Multivariable models were adjusted for age, race, clinic site, education, depression, total energy intake, height, and percent body fat. Greater adherence to a Western dietary pattern (high factor loadings for red meat, fried foods, and high-fat dairy) was associated with higher D3Cr muscle mass (p-trend = .026). Adherence to the Healthy dietary pattern (high factor loadings for fruit, vegetables, whole grains, and lean meats) was not associated with D3Cr muscle mass or DXA ALM. Total protein (β = 0.09, 95% CI = 0.03, 0.14) and nondairy animal protein (β = 0.16, 95% CI = 0.10, 0.21) were positively associated with D3Cr muscle mass. Nondairy animal protein (β = 0.06, 95% CI = 0.002, 0.11) was positively associated with DXA ALM. Associations with other macronutrients were inconsistent. Nondairy animal protein intake (within a Western dietary pattern and alone) was positively associated with D3Cr muscle mass in older men.

Bone-targeted Exercise For Older Men With Osteopenia And Osteoporosis: LIFTMOR For Men Trial Preliminary Findings

PURPOSE The LIFTMOR (Lifting Intervention For Training Muscle and Osteoporosis Rehabilitation) for Men trial was designed to compare the effects of 2 novel bone-targeted exercise programs on risk factors for falls and fracture in men with low bone mineral density (BMD). METHODS LIFTMOR for Men is a 3-arm, 8-month, semi-randomised, intervention trial. Men ≥50 years of age with low BMD, screened for conditions and medications known to affect bone, were recruited. Eligible participants were randomised to 2/week, supervised high-intensity resistance and impact training (HiRIT) or bioDensity (bD) machine-based isometric exercise. Intervention responses are compared with those of a self-selected, non-randomised control (CON) sample of age-matched men following their habitual lifestyles. Outcomes at baseline and follow-up include: anthropometry; DXA-derived lumbar spine (LS) and femoral neck (FN) BMD; physical function (back extensor strength [BES], lower extremity strength [LES], timed-up-and-go [TUG], and 5-times sit-to-stand [STS]); and safety and compliance. Per-protocol analyses of preliminary outcomes were conducted using repeated measures ANCOVA, controlling for age, calcium consumption, prior physical activity, and initial values for BMD [adjusted mean change ± SE and adjusted p values are presented]. RESULTS 93 men (67.1±7.5yr; 82.1±11.6kg; 175.2±6.7cm) with low BMD (FN T-score -1.6±0.6) were recruited, and designated CON (n=26) or randomly assigned to HiRIT (n=34) or bD (n=33). To date, 67 have completed the study and are included in these preliminary findings (21 CON; 24 HiRIT; 22 bD). Compliance is 75.6±17.9% for HiRIT and 81.1±12.1% for bD (NS). Between-group differences have appeared in several outcome measures but only the improvement in LS BMD (HiRIT 0.049±0.01g/cm2 vs CON 0.013±0.01g/cm2; p=0.01) and STS (HiRIT 1.6±0.3s vs bD 0.8±0.3s; p=0.01) have reached significance. Within-group improvements have been observed for LS and FN BMD in both HiRIT and bD, all functional outcomes for HiRIT (all p<0.05), and in LES, TUG, and STS for bD (all p<0.05). There have been no adverse events. CONCLUSION Although preliminary, findings suggest that both novel bone-targeted exercise programs improved BMD and physical function in older men with osteopenia and osteoporosis. Data collection is ongoing.

Unhealthy lifestyles are associated with the increased risk of low-energy fracture in Chinese men ≥ 50years, a population-based survey.

This study aims to investigate the incidence of low-energy fractures in men aged 50 years and older in China and to explore associated risk factors. All the relevant data were available from the China National Fracture Survey (CNFS), which was a cross-sectional survey carried out in eight Chinese provinces (municipalities) between January and May 2015. Through 2014, 76,687 men above 50 years participated in this study and 223 participants had low-energy fractures, indicating the incidence rate 290.8 (95%CI, 252.7-328.9)/100,000 men. Over 80% of the fractures occurred at home and on the common road. The fracture incidence rate presented a significant rising trend with advanced age (p = 0.039). Current smoking, alcohol overconsumption, insufficient sleep duration, and history of past fracture were identified as significant risk factors associated with low-energy fracture (p < 0.05). These results will assist the decisions regarding allocation of healthcare provision to populations of greatest need and aid the design and implementation of strategies to reduce fracture incidence. Accordingly, individuals should be encouraged to reduce alcohol consumption, immediately quit smoking, and get sufficient sleep, especially in those with a history of past fracture. In addition, primary preventives especially home prevention should be emphasized.

Fracture risk after radium-223 (Ra-223) in metastatic castration resistant prostate cancer (mCRPC).

e16513 Background: Ra-223 improves overall survival in patients with mCRPC, but is associated with increased risk of fracture when used in combination with abiraterone and prednisolone. We have assessed time to first new fracture in men with mCRPC receiving Ra-223 monotherapy, imaged using whole body MRI. Methods: In a prospective phase II study, patients with chemotherapy-naïve, bone mCRPC were randomised (1:1) to receive Ra-223 at 55 or 88 kBq/kg for 6 cycles, at 4-week intervals (REASURE; ISRCTN17805587). Whole body MRI was done at baseline, at cycles 2 and 4, and 1 month post-treatment. Subsequent imaging was done as clinically indicated. All scans were centrally reviewed to describe the time to first new fracture and characteristics of fractures. Time to new fracture was analysed using Kaplan Meier methods; comparisons of time to fracture between groups were based on log-rank tests. Results: 36 evaluable patients received a median of 6 cycles of Ra-223; scans were available for 35 patients. For these 35 patients, median age was 75 years (IQR: 73-80). 3 (9%) were receiving bone health agents at trial entry; 8 (23%) had received prior abiraterone or enzalutamide. 21 (60%) patients developed new fractures between randomisation and 2 years after completing treatment with radium-223. The spine was the most common location for fractures (14 patients). Median time to new fracture from randomisation was 10.8 months (95% CI: 6.2-18.2). Freedom from new fracture at 2 years post-randomisation was 21% (95% CI: 7 – 39%). Time to first new fracture was not associated with Ra-223 dose (55 kBq/kg: 10/18 patients experienced a fracture vs 88kBq/kg: 11/17; p = 0.93) or baseline use of bone health agents (3/3 vs 18/32; p = 0.09). Patients with Extent of Disease (EOD) ≥2 (defined as ≥6 metastatic sites/superscan) had earlier time to first new fracture compared to patients with EOD 1 (defined as &lt; 6 metastatic sites) (11/18 vs 10/17; hazard ratio = 2.7, 95% confidence interval = 1.0 – 6.8; p = 0.04). Conclusions: New fractures are commonly seen on imaging in men with mCRPC during and after treatment with Ra-223 monotherapy. This observation supports treatment guidelines that recommend the use of bone health agents in men with mCRPC. Clinical trial information: ISRCTN17805587.

Quantitative Computed Tomography (QCT) of the Distal Forearm in Men Using a Spiral Whole-Body CT Scanner – Description of a Method and Reliability Assessment of the QCT Pro Software

The Mr F study investigates the pathogenesis of low trauma distal forearm fractures in men and includes volumetric bone mineral density (vBMD) measurements at the ultradistal forearm as there are no current data. A standard 64 slice CT scanner was used to determine if it was possible to adapt the existing Mindways quantitative computed tomography Pro software for measuring vBMD values at the hip and spine sites. For calculation of intra- and interobserver reliability 40 forearm scans out of the 300 available were chosen randomly. The images were analyzed using the Slice Pick module and Bone Investigational Toolkit. The 4% length of the radius was chosen by measuring the length of the radius from the scaphoid fossa distally to the radial head. The acquired image then underwent extraction, isolation, rotation, and selection of region of interest in order to generate a report on vBMD. A cross-sectional image was created to allow the generation of data on the cortical and trabecular components separately. Repeat analyses were undertaken by 3 independent observers who were blinded as to whether the image was from a participant with or without fracture. The images were presented in random order at each time point. The following parameters were recorded: cortical cross sectional area, total vBMD, trabecular vBMD, and cortical vBMD (CvBMD). Data were analyzed by calculating intraclass correlation coefficients for intra- and interobserver reliability. The lowest values occurred at the CvBMD with intraobserver reliability of 0.92 (95% confidence interval [CI] of 0.86–0.96) and interobserver reliability of 0.92 (95% CI 0.89–0.96). All other parameters had reliability values between 0.97 and 0.99 with tighter 95% CI than for CvBMD. The method of adapting the Mindways Pro software using a standard CT to produce vBMD and structural data at the ultradistal radius is reliable.

The Association between Objectively Measured Physical Activity and the Gut Microbiome among Older Community Dwelling Men.

To determine the relationship between objectively measured physical activity (PA) and the gut microbiome among community-dwelling older men. Cross-sectional study. Osteoporotic Fractures in Men (MrOS) cohort participants at Visit 4 (2014-16). Eligible men (n=373, mean age 84 y) included participants with 5-day activity assessment with at least 90% wear time and analyzed stool samples. PA was measured with the SenseWear Pro3 Armband and stool samples analyzed for 16S v4 rRNA marker genes using Illumina MiSeq technology. Armband data together with sex, height, and weight were used to estimate total steps, total energy expenditure, and level of activity. 16S data was analyzed using standard UPARSE workflow. Shannon and Inverse Simpson indices were measures of (within-participant) α-diversity. Weighted and unweighted Unifrac were measures of (between-participant) β-diversity. We used linear regression analysis, principal coordinate analysis, zero-inflated Gaussian models to assess association between PA and α-diversity, β-diversity, and specific taxa, respectively, with adjustments for age, race, BMI, clinical center, library size, and number of chronic conditions. PA was not associated with α-diversity. There was a slight association between PA and β-diversity (in particular the second principal coordinate). Compared to those who were less active, those who had higher step counts had higher relative abundance of Cetobacterium and lower relative abundance of taxa from the genera Coprobacillus, Adlercreutzia, Erysipelotrichaceae CC-115 after multivariable adjustment including age, BMI, and chronic conditions. There was no consistent pattern by phylum. There was a modest association between levels of PA and specific gut microbes among community-dwelling older men. The observed associations are consistent with the hypothesis that underlying health status and composition of the host microbiome are related.

In older postmenopausal women with osteopenia, zoledronate reduced fragility fractures at 6 years.

ACP Journal Club16 April 2019In older postmenopausal women with osteopenia, zoledronate reduced fragility fractures at 6 yearsKristine E. Ensrud, MD, MPH, MACP, Carolyn J. Crandall, MD, MS, FACPKristine E. Ensrud, MD, MPH, MACPUniversity of Minnesota and, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA (K.E.E.)Search for more papers by this author, Carolyn J. Crandall, MD, MS, FACPUniversity of California, Los Angeles, California, USA (C.J.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJ201904160-042 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationReid IR, Horne AM, Mihov B, et al. Fracture prevention with zoledronate in older women with osteopenia. N Engl J Med. 2018;379:2407-16. https://pubmed.ncbi.nlm.nih.gov/30575489Clinical Impact RatingsGIM/FP/GP: Endocrinology: Geriatrics: References1 Cummings SR, Black DM, Thompson DE, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA. 1998;280:2077-82. [PMID: 9875874] Google Scholar2 Black DM, Delmas PD, Eastell R, et al; HORIZON Pivotal Fracture Trial. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007;356:1809-22. [PMID: 17476007] Google Scholar3 Gedmintas L, Solomon DH, Kim SC. Bisphosphonates and risk of subtrochanteric femoral shaft, and atypical femur fracture: a systematic review and meta-analysis. J Bone Miner Res. 2013;28:1729-37. [PMID: 23408697] Google Scholar4 Black DM, Geiger EJ, Li BH, et al. Bisphosphonate use and risk of AFF varies by pre-treatment BMD level: results from the Southern California Osteoporosis Cohort Study (SOCS). J Bone Miner Res. 2018;33(Suppl 1):2 (abstract no. 1007). www.asbmr.org/education/AbstractDetail?aid=94cf315c-de77-4e44-bbf3-acde8c9749fb (accessed 11 Feb 2019). Google Scholar5 Solomon DH, Johnston SS, Boytsov NN, et al. Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. J Bone Miner Res. 2014;29:1929-37. [PMID: 24535775] Google Scholar6 Qaseem A, Forciea MA, McLean RM, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Treatment of low bone density or osteoporosis to prevent fractures in men and women: a clinical practice guideline update from the American College of Physicians. Ann Intern Med. 2017;166:818-39. [PMID: 28492856] Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Minnesota and, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA (K.E.E.)University of California, Los Angeles, California, USA (C.J.C.)This article was published at Annals.org on 2 April 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 16 April 2019Volume 170, Issue 8Page: JC42KeywordsBone mineral densityDrugsHip fracturesNumber needed to treatOdds ratioOsteopeniaOsteoporosisResearch fundingSerious adverse eventsSystemic diseases ePublished: 16 April 2019 Issue Published: 16 April 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Hypercholesterolaemia increases the risk of high‑turnover osteoporosis in men.

As the incidence of osteoporosis (OP) and hypercholesterolaemia in men has increased, male OP has drawn more attention from clinicians worldwide. The present study sought to investigate the effects of cholesterol on male bone. Between July 2015 and October 2015, 216 men (aged ≥18 years) were recruited for this cross-sectional study. To test our clinical hypothesis, we designed two male animal models: Exogenous hypercholesterolaemia induced by a high-cholesterol diet (HCD) and endogenous hypercholesterolaemia induced by apolipoprotein E (ApoE) knockout. Finally, the direct effects of cholesterol on osteoblasts were observed in cell experiments. In our clinical studies, men with hypercholesterolaemia displayed a lower bone mineral density (BMD) and increased beta collagen cross-linking (beta-CTX) and type I anterior collagen amino terminal peptide (PINP) levels compared to those of the control subjects. Serum cholesterol levels were a significant independent predictor of BMD, beta-CTX and PINP and were negatively correlated with BMD and positively correlated with beta-CTX and PINP levels. Our animal experimental results validated our clinical results, as they also indicated that hypercholesterolaemia damages bone microstructure and reduces bone strength. Cholesterol directly increased osteoblast functional gene expression in vitro. Hypercholesterolaemia increases the risk of high-turnover osteoporosis in men at least in part by excessively promoting the activity of the remodelling pathway. In addition, hypercholesterolaemia damages the bone microstructure, resulting in osteopenia or OP and reduced bone strength, leading to a higher risk of fracture in men. We emphasize the importance of preventing and treating hypercholesterolaemia as well as monitoring bone metabolic markers and BMD in men with hypercholesterolemia for the effective prevention of bone loss and subsequent fracture. In addition, our findings provide a theoretical basis for the development of treatments for high cholesterol-induced osteoporosis in men.

Correlates of T50 and relationships with bone mineral density in community-living older men: the osteoporotic fractures in men (MrOS) study.

T50 is a novel serum-based marker that assesses the propensity of calcification in serum. Shorter T50 indicates greater propensity to calcify and it has been associated to cardiovascular disease (CVD) and mortality among patients with kidney disease. In the general population, neither the correlates of T50 nor the relationships of T50 with bone mineral density (BMD) are known. We performed a nested cross-sectional study selecting 150 individuals at random among participants from the Osteoporotic Fractures in Men (MrOS) Study, a study of community-living older men. We categorized individuals into tertiles of T50 and compared demographics and disease indicators across tertiles. We utilized linear regression to evaluate the cross-sectional association between T50 and hip and spine BMD in multivariable models. Older age was associated with shorter T50. Kidney function tended to be lower in those with shorter T50 and the prevalence of CVD and peripheral arterial disease in those with shorter T50, albeit these findings did not achieve statistical significance. We found no statistically significant associations between T50 and total hip or total spine BMD in either unadjusted or multivariable adjusted models. T50, a novel indicator of serum calcification propensity, is not associated with BMD in community-living older men. Future larger studies should determine if T50 may give insights to CVD in the general population above and beyond traditional risk factors.

Anemia and Risk of Fractures in Older Korean Adults: A Nationwide Population-Based Study.

Anemia is a common health problem in older adults and is associated with risk factors for fracture such as low physical function and low bone mass. The aim of this study was to examine the relationship between anemia and fracture risk in older adults. We conducted a retrospective cohort study from 2003 to 2013. The participants were community-dwelling Korean adults aged 65 years and older who participated in the National Health Screening Program (n = 72,131) between 2003 and 2008. Anemia (<12 g/dL for women and <13 g/dL for men) and severity of anemia (mild: 11 g/dL ≤ Hb < 12 g/dL; moderate to severe: Hb < 11 g/dL) were defined by World Health Organization (WHO) criteria. The incidence of any fractures, vertebral fractures, and femur fractures was identified using ICD-10 codes. Cox proportional hazard regression models were used to assess risk of fracture according to anemia. Anemia was associated with increased risk of fracture in men (any: adjusted hazard ratio [aHR] = 1.29, 95% confidence interval [CI] 1.18-1.41; vertebral: aHR = 1.20, 95% CI 1.03-1.40; femur: aHR = 1.71, 95% CI 1.44-2.04), and less strongly but still significantly in women (any: aHR = 1.10, 95% CI 1.11-1.41; vertebral: aHR = 1.11, 95% CI 1.03-1.20; femur: aHR = 1.37, 95% CI 1.25-1.52). Higher risk was observed in subjects with moderate-to-severe anemia in both sexes. Considering the high prevalence of anemia in older adults, it is important that health professionals recognize increased fracture risk in older adults with anemia. © 2019 American Society for Bone and Mineral Research.

Temporal stability of urinary cadmium in samples collected several years apart in a population of older persons.

There is growing evidence that urine cadmium is a temporally stable biomarker indicative of long-term cadmium exposure; however questions remain with regard to generalizability to older persons, the impact of changes in smoking behavior, and the degree of temporal stability when repeat sample collection spans years instead of weeks or months. Using archived samples from cohorts of older men (Osteoporotic Fractures in Men (MrOS-US)) and women (Study of Osteoporotic Fractures (SOF)) (mean age = 80 at study visit 2), we analyzed two morning urine samples each from 39 men and 18 women with a diverse self-reported smoking history. For MrOS, samples were collected approximately 6 years apart, and 4 years apart for SOF. Intra-class correlations were computed to assess temporal stability, and adjusted for age and body mass index. The median creatinine-adjusted urinary cadmium levels (0.39 μg/g for men, 0.89 μg/g for women) were similar to levels expected for these age/sex groups in the US according to the National Health and Nutrition Examination Survey. The overall intra-class correlation was high (ICC = 0.85; 95% CI: 0.76-0.91) and similar between cohorts (MrOS: ICC = 0.74; 95% CI: 0.58-0.86; SOF: ICC = 0.81; 95% CI: 0.59-0.93), but slightly lower among those who stopped smoking between visits of sample collection (ICC = 0.64; 95% CI: 0.31-0.87) or among former smokers who quit prior to the first sample collection (ICC = 0.68; 95% CI: 0.25-0.93). We report good-to-excellent reproducibility of urine cadmium using morning urine samples collected 4-6 years apart from older men and women, but slightly lower correlations among those with a history of smoking. Single measures of urine cadmium are a reliable biomarker in older men and women.

Sex- and Sport-Specific Epidemiology of Cervical Spine Injuries Sustained During Sporting Activities

Although several investigations have examined the epidemiology of cervical spine injuries in sports, few studies have analyzed the nationwide incidence and sex-specific epidemiology of cervical spine injuries. The National Electronic Injury Surveillance System database, which collects information on patients presenting to the emergency department at 100 hospitals across the United States, was queried for neck sprains and cervical fractures associated with sporting activities from 2000-2015. A total of 26,380 neck sprains and 1166 fractures were identified. Compared with females, the incidence for injuries in males was 1.7 times greater for neck sprains and 3.6 times greater for fractures (P < 0.0001). Football was the most common cause of cervical sprains in males, followed by cycling and weightlifting/aerobics. Females sustained most neck sprains in weightlifting/aerobics, trampoline, and cheerleading. From 2000 to 2015, the incidence of neck sprains from aerobics increased from 15.5 to 25.3 per million person-years (P < 0.0001). Similarly, the incidence of cervical fractures from cycling increased from 0.67 to 2.7 per million (P < 0.0001). For males, cycling was the most common cause of fracture, followed by diving/swimming and football. For females, horseback riding was most common, followed by cycling and diving/swimming. Football is the leading cause of cervical sprains in the United States. The most common cause of cervical fracture in men is cycling, while in women it is horseback riding. The incidence of sport-related cervical fractures has increased by 35% from 2000 to 2015, which has been driven by an increase in cycling-related injuries.

Prediction of incident vertebral fracture using CT-based finite element analysis.

We aimed to determine the association between vertebral strength by quantitative computed tomography (CT)-based finite element analysis (FEA) and incident vertebral fracture (VF). In addition, we examined sensitivity and specificity of previously proposed diagnostic thresholds for fragile bone strength and low BMD in predicting VF. In a case-control study, 26 incident VF cases (13 men, 13 women) and 62 age- and sex-matched controls aged 50 to 85years were selected from the Framingham multi-detector computed tomography cohort. Vertebral compressive strength, integral vBMD, trabecular vBMD, CT-based BMC, and CT-based aBMD were measured from CT scans of the lumbar spine. Lower vertebral strength at baseline was associated with an increased risk of new or worsening VF after adjusting for age, BMI, and prevalent VF status (odds ratio (OR) = 5.2 per 1 SD decrease, 95% CI 1.3-19.8). Area under receiver operating characteristic (ROC) curve comparisons revealed that vertebral strength better predicted incident VF than CT-based aBMD (AUC = 0.804 vs. 0.715, p = 0.05) but was not better than integral vBMD (AUC = 0.815) or CT-based BMC (AUC = 0.794). Additionally, proposed fragile bone strength thresholds trended toward better sensitivity for identifying VF than that of aBMD-classified osteoporosis (0.46 vs. 0.23, p = 0.09). This study shows an association between vertebral strength measures and incident vertebral fracture in men and women. Though limited by a small sample size, our findings also suggest that bone strength estimates by CT-based FEA provide equivalent or better ability to predict incident vertebral fracture compared to CT-based aBMD. Our study confirms that CT-based estimates of vertebral strength from FEA are useful for identifying patients who are at high risk for vertebral fracture.

Management of Male Osteoporosis: an Update

Osteoporosis is a major health concern for men in our aging population. The incidence of osteoporotic fractures in men is expected to rise as life expectancy increases. When adjusted for age, one half of all hip fractures occur in men and of all osteoporotic fractures; hip fractures account for the highest morbidity and mortality. Several factors contribute to bone loss in men. Sex steroid deficiency plays an important role in male age-related bone loss. Careful evaluation for secondary causes of bone loss (including lifestyle factors, comorbidities, and risk medications) is warranted. Osteoporosis guidelines recommend bone mineral density (BMD) testing in men over age 70, earlier in men with other risk factors. As in women, adequate calcium and vitamin D intake, regular weight-bearing exercise, smoking cessation, limiting excessive alcohol, and fall prevention strategies are recommended. Available clinical data support efficacy of bisphosphonates (alendronate, risedronate, zoledronic acid), denosumab, and anabolic therapy (teriparatide) in men with osteoporosis as well as in women. Abaloparatide, a parathyroid hormone-related peptide analog with demonstrated anti-fracture efficacy in women, awaits the conclusion of clinical trials in men. Romosozumab shows similar BMD and bone turnover marker effects in osteoporotic men compared to women; evaluation of safety concerns is ongoing. Recent insights into osteoporosis pathophysiology and bone cell biology provide promising direction for effective therapeutic strategies for the management of male osteoporosis.

Physical function tests predict incident falls: A prospective study of 2969 men in the Swedish Osteoporotic Fractures in Men study

Aims: Falls are common in the elderly population, and fall-related injuries are a major health issue. We investigated the ability of simple physical tests to predict incident falls. Methods: The Swedish Osteoporotic Fractures in Men (MrOS) study includes 3014 population-based men aged 69-81 years at the start of the study. These men performed five different physical tests at baseline: right-hand grip strength, left-hand grip strength, timed stand test, 6 m walking test (time and steps) and narrow walking test. During the first study year, we asked participants to fill out questionnaires regarding falls 4, 8 and 12 months after baseline. A total of 2969 men completed at least one questionnaire and were included in this study. We used generalised estimating equations and logarithmic regression models to estimate odds ratios for fallers and recurrent fallers (more than one fall during the one-year examination period) in each quartile of men for each physical test. Results: The proportions of fallers and recurrent fallers were higher in the lowest quartile of the physical tests than in the other three quartiles combined for all physical tests. A reduction of one standard deviation in respective physical test resulted in a 13-21% higher risk of becoming a faller and a 13-31% higher risk of becoming a recurrent faller. Conclusions: Low results on simple physical tests is a risk factor for incident falls in elderly Swedish men and may facilitate identification of high-risk individuals suitable for fall-intervention programs.