Fracture Risk In Men Research Articles

Associations of Serum Testosterone and Sex Hormone-Binding Globulin with Incident Fractures in Middle-Aged to Older Men.

As men age, circulating testosterone (T) decreases, circulating sex-hormone binding globulin (SHBG) increases, and risk of fracture increases. It is unclear if circulating T, independently of comorbidities, is associated with fracture risk in men. To determine associations for T and SHBG with incident fractures in men. We utilized the large (n=205,973 participants, 11,088 any fracture cases, 1,680 hip fracture cases, 1,366 forearm fracture cases) and well-characterized UK Biobank cohort. Associations were modelled using Cox regressions, adjusting for multiple comorbidities/covariates, imputing for missing information, and assessing non-linearity using cubic splines. For T, not considering SHBG, there was a non-linear association with hip but not forearm fractures, with the lowest risk in the second quintile. However, in models adjusted for SHBG or using calculated free T, lower T was associated with higher risk for fractures at all evaluated bone sites. Lower SHBG was strongly associated with lower risk of hip and forearm fractures (Q1 vs Q5, hip 0.55, 0.47-0.65; forearm 0.62, 0.52-0.74). Low circulating SHBG is strongly associated with low risk of fracture at all evaluated bone sites, while the associations of circulating T with fracture risk are of lesser magnitude, non-linear, inconsistent among fracture site, and affected by adjustment for SHBG. These findings demonstrate that circulating SHBG, rather than T, is a major independent biomarker of fracture risk in men. Consequently, both total T and SHBG should be assessed when examining the relationship of endogenous T concentrations with fractures in middle-aged to older men.

8377 Associations of Serum Testosterone and Sex Hormone-Binding Globulin with Incident Fractures in Middle-Aged to Older Men

Abstract Disclosure: L. Grahnemo: None. R.J. Marriott: None. K. Murray: None. L. Tyack: None. M. Nethander: None. A.M. Matsumoto: None. E.S. Orwoll: None. D. Vanderschueren: None. B.B. Yeap: None. C. Ohlsson: None. As men age, their circulating testosterone (T) decreases, circulating sex-hormone binding globulin (SHBG) increases, and risk of bone fracture increases. Unexpectedly, a recent large clinical trial reported that T treatment increased fracture risk in men. It is unclear if circulating T, independently of comorbidities, is associated with male fracture risk. We tested the hypothesis that serum T concentration is an independent risk predictor for incident bone fractures in men. We analyzed associations for T and SHBG with incident fractures in the large and well-characterized UK Biobank cohort (205,973 male participants median age 58 years, excluding men on androgen-related therapies). Baseline serum total T and SHBG were measured by immunoassay, and incident fractures documented over a median follow-up of 13.6 years (11,088 any fracture cases; 1,680 hip fracture cases; 1,366 forearm fracture cases). Associations of hormonal variables with fracture outcomes were modelled using Cox regression, adjusted for multiple comorbidities/covariates, with imputation for missing data, and non-linearity assessed using cubic splines. For total T, in multivariable models not including SHBG, there was a non-linear association with any fracture and hip fractures but not forearm fractures, with the lowest risk in the second quintile (Q2; hazard ratio (HR), 95% confidence intervals (CIs) Q2 vs Q5 any fracture 0.89, 0.84-0.94; hip fracture 0.76, 0.66-0.87; forearm fracture 0.97, 0.83-1.13). However, in multivariable models analyzing total T which were adjusted for SHBG, lower total T was associated with higher risk for fractures at all evaluated bone sites (HR, 95% CIs Q1 vs Q5 any fracture 1.24, 1.16-1.33; hip fracture 1.28, 1.08-1.51; forearm fracture 1.51, 1.25-1.82). Similar results were seen in multivariable models using calculated free T values. Lower SHBG concentration was associated with lower risk of any fracture, hip fractures, and forearm fractures, in multivariable models not including total T (HR, 95% CIs Q1 vs Q5, any fracture 0.71, 0.67-0.75; hip fracture 0.55, 0.47-0.65; forearm fracture 0.62, 0.52-0.74), with similar results following additional adjustment for total T. In conclusion, associations of total T concentrations with fracture risk without adjustment for SHBG are non-linear and inconsistent, whereas lower total T concentration, adjusted for SHBG, was independently associated with higher risks of any fracture, hip fractures, and forearm fractures. Lower circulating SHBG, without or with adjustment for total T, was strongly associated with lower risk of fractures at all three sites, consistent with SHBG being a major independent biomarker of fracture risk in men. When examining the relationship of endogenous T concentrations with health outcomes influenced by androgen-sensitive tissues in middle-aged to older men, both total T and SHBG concentrations should be assessed. Presentation: 6/2/2024

The risk of fragility fractures in men with prostate cancer treated with androgen deprivation therapy.

Androgen Deprivation Therapy (ADT) is known to increase long-term fracture risk in men with prostate cancer (PCa), although the risk of fragility fractures remains unclear. This study aims to evaluate the risk of fragility and malignancy-related fractures in men with PCa treated with ADT. We conducted a retrospective cohort study of men with PCa. Follow-up time was divided into 30-day intervals and exposure (current, past, or no-ADT use). Current ADT use was stratified by duration of ADT use (≤ 182days, 183-730days, and > 730days). Cause-specific Cox proportional hazard models were used to estimate the risk of fractures. We included 471 patients (mean age 70.5 (± 8.3) years). The mean follow-up time was 5.0 (± 1.7) years in patients who never started ADT, 3.4 (± 2.3) years and 4.1 (± 2.0) years in patients who started ADT at baseline and during follow-up, respectively. In total, 60 patients had a fracture, 48 (80%) fragility, and 12 (20%) malignancy-related fractures. Current ADT use was associated with a higher risk of all fractures (HR 5.10, 95% CI 2.34-11.13) and fragility fractures (HR 3.61, 95% CI 1.57-8.30). The association with malignancy-related fractures could not be studied due to no events during no-ADT use. There was an increased risk of all fractures with longer duration of ADT use. Current ADT use was associated with a higher risk of fragility fractures than no-ADT use. A higher fracture risk was observed within the first six months of ADT use and persisted for longer durations.

Fracture risk revisited: Bone mineral density T-score and fracture risk in type 2 diabetes.

To study the association between femoral neck (FN) bone mineral density (BMD) T-score and fracture risk in individuals with and without type 2 diabetes (T2D). We performed a single-centre retrospective cohort study using the Danish National Health Service. BMD of the FN was measured by dual-energy X-ray absorptiometry. Cox proportional hazards regression models were used to study the association between FN BMD T-score and fractures in individuals with and without T2D separately, adjusted for age, comorbidities and comedication. The results from this analysis were used to estimate the 10-year absolute fracture risk. In total, there were 35,129 women (2362 with T2D) and 7069 men (758 with T2D). The FN BMD T-score was significantly associated with risk of any, hip and major osteoporotic fracture in men and women with [adjusted hazard risk ratios (aHR) women, hip: 1.57; 95% confidence interval (CI) 1.24-2.00, incidence rate (IR) 8.7; aHR men, hip: 1.55; 95% CI 1.01-2.36, IR 4.6] and without T2D (aHR women, hip: 1.75; 95% CI 1.64-1.87, IR 7.0; aHR men, hip: 1.97, 95% CI 1.73-2.25, IR 6.3), and its ability to predict fracture risk was similar. Fracture IRs were not significantly different for individuals with or without T2D, nor was the estimated cumulative 10-year fracture risk. The FN BMD T-score was significantly associated with hip, non-spine and major osteoporotic fracture risk in men and women with and without T2D. Fracture risk for a given T-score and age was equal in individuals with and without T2D, as was the ability of the FN BMD T-score to predict fracture risk.

Trends in hip fracture rates in US male veterans.

In the United States, the annual incidence of osteoporotic hip fracture is estimated to be 250,000 to 300,000; the one-year mortality in some studies has been as high as 32%. Reports that hip fracture rates in US women 65years and older may no longer be declining led to this investigation of hip fracture in men, a less studied population. We assessed the trends in the incidence of hip fracture in US male veterans 50years and older of age as well as the rates of diagnosis and treatment in such men. We assessed the recent trends of hip fracture incidence in a nation-wide male veteran population 50years and older of age. Using data from the US Veterans Affairs Informatics and Computing Infrastructure (VINCI) 2002-2019, we calculated the annual age-standardized hip fracture incidence. Secondary objectives included evaluating the annual proportion of hip fracture patients who underwent dual-energy X-ray absorptiometry (DXA) before or after the fracture and/or received osteoporosis medication after the hip fracture over the study period. Hip fracture incidence increased in male veterans from 2006 to 2019. Fewer than 6% of men underwent a DXA scan and fewer than 0.5% received osteoporosis medications up to two years after a hip fracture. Despite available screening methods such as DXAs and medications for primary and secondary prevention of osteoporotic fractures, hip fracture incidence is not decreasing in older male veterans. Our study highlights a need for closerattention to fracture risk in men.

Predicting the probability of osteoporotic fracture risk in men versus women: do we need specific reference interventional thresholds for men?

BackgroundGender differences in the diagnosis and treatment of osteoporosis is a relatively common phenomenon, particularly amongst those patients under 80 years of age presenting with fragility fractures. The clinical implications of these findings are that strategies, which tend to focus on osteoporosis management in women, should also pay enough attention to osteoporosis in men. However, there have been questions whether there is a gender difference when setting intervention thresholds for osteoporosis management. This work was carried out aiming to determine the fracture probabilities calculated by FRAX at which therapeutic intervention in older men and women can be considered.ResultsAssessment of fracture risk probability thresholds in men revealed that for hip fractures, ROC was 0.754 (95% CI: 0.69–0.817). The sensitivity was 80.5% for threshold probabilities of 2.5%. For the major osteoporosis fracture, ROC was 0.828 (95% CI: 0.694–0.963). The sensitivity was 87.5% for threshold probabilities of 10%. Assessment of fracture risk probability threshold in women ROC was 0.760 (95% CI: 0.691–0.83). The sensitivity was 76.1% for threshold probabilities of 3%. For major osteoporosis fracture, ROC was 0.848 (95% CI: 0.784–0.912). The sensitivity was 87.3% for threshold probabilities of 15%.ConclusionOperational aspects of osteoporosis management should consider gender specific fracture thresholds. Interventional thresholds were found to be different in men compared to women. This helps to optimise fracture prevention in older men.

Assessment and management of fracture risk in men with prostate cancer taking androgen deprivation therapy: a retrospective observational primary care database study.

Prostate Cancer (PCa) is the commonest cancer in the UK. Androgen deprivation therapy (ADT) is a mainstay of treatment. It increases fragility fractures causing a huge burden to patients and the NHS. As men live longer with PCa, many require prolonged ADT. Reducing fracture risks and improving cancer survivorship is becoming increasingly important. Primary care plays an important role. To evaluate how fracture risk of PCa patients taking ADT (PCa-ADT) was assessed and managed in primary care. A retrospective multi-practice database study. PCa patients were identified using SNOMED codes from five sociodemographically diverse practices (registered population 49 400). Data were extracted by hand-searching records, including hospital letters, and included: demographics; a 10-year fragility fracture score (FRAX); NOGG intervention threshold; DEXA requests; and use of bisphosphonates. Of the 261 PCa patients identified, 6% were Black African/Caribbean and 89% White British. Half had been prescribed ADT, 28% being current users. No fracture risk assessment was documented for any patients. ADT current users had significantly increased FRAX scores for both major osteoporotic fractures (MOF) (9.61%±1.12%) and hip fracture (HF) (5.30%±1.02%) compared with PCa patients without ADT (7.08%±0.57% [MOF] and 3.06%±0.46% [HF], P<0.001). For ADT current users, 39% showed intermediate fracture risk (NOGG amber), warranting a DEXA scan, with only 30% performed. Patients in more affluent areas received more DEXA scans and bisphosphonate treatment. Osteoporosis is underdiagnosed and undertreated in men with PCa-ADT, especially in those with deprived backgrounds. There is an unmet need to manage the fracture prevention in this population.

P076 Exploring the correlation between body mass index and fracture risk in men

Abstract Background/Aims There has been an increase in interest in identifying patients with high risk of fracture, due to the high mortality. In De Laet et al. (2005) meta-analysis on 60000 women and men, which analysed the effect of body mass index (BMI), bone mineral density (BMD), age and gender on risk of any fracture; low BMI is linked to significantly higher fracture risk (two-fold at BMI of 20) when compared with a BMI 25. On the same comparison, high BMI (30) reduced risk of fractures by 17% (RR 0.83). This was significant in women, but not in men. No newer large-scale study focused on the correlation between BMI and fracture risks in men. Therefore, we set out to investigate the relationship between BMI and different fractures in male patients. Methods 5388 male patients referred for DEXA scan in the North West of England between 2004 and 2019 were included in the analysis. Logistic regression is performed for age, BMI, and BMD using R-4.3.1 for Windows. Results Prior to adjusting for BMD, low BMI is a significant risk factor for femur fracture. On the other hand, low BMI is a protective factor against tibia-fibula fractures. There was no significant correlation detected in spine, rib, humerus, forearm and elbow fractures. After adjusting for BMD, higher BMI is associated with significantly higher odds of humerus, tibia-fibula and wrist fractures, but no statistically significant association with spine, ribs and femur fractures. Conclusion Our results show the correlation between BMI, adjusted for BMD, and different fracture site. Our findings corroborated with previous literature, suggesting that BMI is likely a risk factor that is dependent on BMD. Furthermore, we highlighted that higher BMI is a protective factor for some fractures whilst being a risk factor for others. It is unclear whether the difference between the fracture types are due to the mechanism of fracture or the difference in disease progression at the different fracture sites - this is a potential area for future research. Disclosure M.H. Nguyen: None. M. Bukhari: None.

Evidence-Based Guideline for the management of osteoporosis in men.

Historically, osteoporosis has been viewed as a disease of women, with research, trials of interventions and guidelines predominantly focused as such. It is apparent, however, that this condition causes a substantial health burden in men also, and that its assessment and management must ultimately be addressed across both sexes. In this article, an international multidisciplinary working group of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases presents GRADE-assessed recommendations for the diagnosis, monitoring and treatment of osteoporosis in men. The recommendations are based on a comprehensive review of the latest research related to diagnostic and screening approaches for osteoporosis and itsassociated high fracture risk in men, covering disease burden, appropriate interpretation of bone densitometry (including the use of a female reference database for densitometric diagnosis in men) and absolute fracture risk, thresholds for treatment, andinterventions that can be used therapeutically and their health economic evaluation. Future work should specifically address the efficacy of anti-osteoporosis medications, including denosumab and bone-forming therapies.

Androgen deprivation therapy-related fracture risk in prostate cancer: an insurance claims database study in Japan

IntroductionAndrogen deprivation therapy (ADT) is widely used for the treatment of prostate cancer. ADT is associated with reduced bone density leading to an increased risk of osteoporotic fracture. The objective of this retrospective cohort study was to quantify fracture risk in men treated with ADT for prostate cancer in real-world practice in Japan.Materials and methodsData were extracted from the Japanese Medical Data Vision (MDV) database. Men initiating ADT for treatment of prostate cancer between April 2010 and March 2021 were identified and matched to a cohort of prostate cancer patients not taking ADT using a propensity score. Fracture rates were estimated by a cumulative incidence function and compared between cohorts using a Cox cause-specific hazard model. Information was extracted on demographics, comorbidities and bone densitometry.Results30,561 men with PC starting ADT were matched to 30,561 men with prostate cancer not treated with ADT. Following ADT initiation, <5% of men underwent bone densitometry. Prescription of ADT was associated with an increased fracture risk compared to not taking ADT (adjusted hazard ratio: 1.63 [95% CI 1.52–1.75]).ConclusionADT is associated with a 1.6-fold increase in the risk of osteoporotic fracture in men with prostate cancer. Densitometry in this population is infrequent and monitoring urgently needs to be improved in order to implement effective fracture prevention.

When Cortical Bone Matrix Properties Are Indiscernible between Elderly Men with and without Type 2 Diabetes, Fracture Resistance Follows Suit.

Type 2 diabetes mellitus (T2DM) is a metabolic disease affecting bone tissue and leading to increased fracture risk in men and women, independent of bone mineral density (BMD). Thus, bone material quality (i.e., properties that contribute to bone toughness but are not attributed to bone mass or quantity) is suggested to contribute to higher fracture risk in diabetic patients and has been shown to be altered. Fracture toughness properties are assumed to decline with aging and age-related disease, while toughness of human T2DM bone is mostly determined from compression testing of trabecular bone. In this case-control study, we determined fracture resistance in T2DM cortical bone tissue from male individuals in combination with a multiscale approach to assess bone material quality indices. All cortical bone samples stem from male nonosteoporotic individuals and show no significant differences in microstructure in both groups, control and T2DM. Bone material quality analyses reveal that both control and T2DM groups exhibit no significant differences in bone matrix composition assessed with Raman spectroscopy, in BMD distribution determined with quantitative back-scattered electron imaging, and in nanoscale local biomechanical properties assessed via nanoindentation. Finally, notched three-point bending tests revealed that the fracture resistance (measured from the total, elastic, and plastic J-integral) does not significantly differ in T2DM and control group, when both groups exhibit no significant differences in bone microstructure and material quality. This supports recent studies suggesting that not all T2DM patients are affected by a higher fracture risk but that individual risk profiles contribute to fracture susceptibility, which should spur further research on improving bone material quality assessment in vivo and identifying risk factors that increase bone fragility in T2DM. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

КАРДИОВАСКУЛЯРНАЯ ПАТОЛОГИЯ И ПРОГНОЗИРОВАНИЕ ПЕРЕЛОМОВ У МУЖЧИН СТАРШЕ 45 ЛЕТ

Introduction. The combination of cardiovascular pathology with osteoporosis and fractures in men, especially at a younger age, requires the study of the causes and risk factors for the strategy of early diagnosis, treatment and prevention. Target. To study the clinical and pathogenetic relationships of cardiovascular pathology with the risk of fractures in men over 45 years of age. Materials and methods: 201 men over the age of 45 were examined, mean age 51.1 [46.1; 56.3]. The accuracy and statistical significance of the distribution of groups was assessed using discriminant analysis. High values of canonical correlation (Canonic.R=0.941) and chi-square test (χ²=630.4) with zero probability of not rejecting the null hypothesis (p=0.000) and coincidence of the results of discrimination and cluster analysis in 95% of cases made it possible to assume the reliability of the model , built on the basis of the proposed variables. Results. The frequency of risk factors in the examined patients was: smoking - 107 people. (53.2%), abdominal obesity 74 people. (36.8%); arterial hypertension - 75 people. (37.3%), hypercholesterolemia (total cholesterol&gt; 5.0 mmol / l) - 39 people. (19.4%), increased low-density lipoprotein cholesterol (LDL cholesterol)&gt; 3.0 mmol / l - 32 people. (15.9%), hypertriglyceridemia (TG&gt; 1.7 mmol / l) - 27 people. (13.4%); fasting glycemia or diabetes mellitus - 28 people. (13.9%). Among patients with fractures, men with an increased body mass index (26.5±3.3 kg/m² and 24.1±4.5 kg/m² p=0.008) and abdominal obesity (104.1±7.0 and 100.1±6.2 cm, p=0.004), vitamin D deficiency or insufficiency (37 (18.4%) versus 4 (1.9%) p=0.000) and androgen deficiency (15 (7 .4%) and 7 (3.4%) p=0.048). Fractures were significantly more often associated with diabetes mellitus (19 (9.4%) and 4 (1.9%) p=0.029), respectively. Based on the identified factors, the discriminant analysis made it possible to build a mathematical model for predicting fractures in men over 45 years of age. The canonical correlation coefficient R was 0.841. Wilkson's lambda statistics values of 0.292 indicate good discrimination (with χ² - 223.7 p&lt;0.01). The established most significant signs were assigned gradations (X1 - 6) and numerical values, where: X1 - history of fractures: no - 0, yes - 1; Х2 – age of the first fracture older than 50 years: no – 0, yes – 1; smoking: no - 0, yes - 1; diabetes mellitus: no - 0, yes - 1; walking less than 1 hour a day: no - 0, yes - 1; X6 - osteoporosis or osteopenia: no - 0, yes - 1. X1-X6 values are standardized initial data calculated by the formula: Z = (X I - X) / s, where Z - initial distribution values, X I - results dimensions of the distribution with the original dimension. The values of the constants F1 and F2 are determined: F1 = -5.99; F2 = -4.54. Having established the gradations and numerical values of the risk factors, the predictive coefficients F1 and F2 are determined according to the following formulas: F1= -5.99–0.854×X1–0.192×X2+0.855×X3–0.179×X4+8.755×X5+3.904×X6. F2= –4.54+1.24×X1+ 2.94×X2+2.165×X3+1.60×X4–0.77×X5+5.75×X6. With an absolute value of F2 greater than the absolute value of F1, a high risk is predicted, and with an F2 value less than F1, a low risk of fractures in comorbid men is predicted. Conclusions. Among men in a random sample over 45 years of age, a high incidence of cardiovascular risk factors was established. A third of the examined men had bone fractures of various localization. The mathematical model makes it possible to predict the development of fractures in men over 45 years of age, the risk of which increases in the presence of the following risk factors: a history of fractures before the age of 50, physical inactivity, smoking, the presence of diabetes mellitus and osteoporosis according to x-ray osteodensitometry.

Antipsychotic medication use and fracture: a case–control study

It has been reported that antipsychotic use is associated with lower bone mineral density and bone quality. We aimed to determine whether antipsychotic use is associated with fracture risk in a population-based sample of adults living in the Barwon Statistical Division, south-eastern Australia. In this case–control study, 1458 participants (51.8% women) with radiologically confirmed fracture between June 1st 2012 and May 31st 2013 (cases) were compared with 1795 participants (46.5% women) without fracture (controls) for the same time period. Medication use, medical history and lifestyle factors were documented by self-report. Multivariable binary logistic regression was used to explore associations between antipsychotic use and fracture following adjustment for possible confounders. In women, antipsychotic use was identified for 20 of 755 (2.6%) cases and 10 of 834 (1.2%) controls (p = 0.034) and in men, antipsychotic use was identified for 13 of 703 (1.8%) cases and 5 of 961 (0.5%) controls (p = 0.010). Following adjustments, antipsychotic use was associated with a 3.0-fold increased risk of fracture in men and a 2.3-fold increased risk of fracture in women. Patterns persisted after exclusion of participants with non-fragility fractures and self-reported schizophrenia. While future research exploring underlying mechanisms is needed, regular monitoring of bone health in antipsychotic users is suggested.

Interactions Between HR-pQCT Bone Density and D3 Cr Muscle Mass (or HR-pQCT Bone Structure and HR-pQCT Muscle Density) in Predicting Fractures: The Osteoporotic Fractures in Men Study.

We examined if an interaction exists between bone and muscle in predicting fractures in older men. Prospective data from the Osteoporotic Fractures in Men study was used to build Cox proportional hazards models. Predictors included HR-pQCT total volumetric BMD (Tt.BMD), trabecular BMD (Tb.BMD), cortical BMD (Ct.BMD) and cortical area (Ct.Ar) at distal radius/tibia, HR-pQCT muscle volume and density (diaphyseal tibia), D3 -creatine dilution (D3 Cr) muscle mass, and grip strength and leg force, analyzed as continuous variables and as quartiles. Incident fractures were self-reported every 4 months via questionnaires and centrally adjudicated by physician review of radiology reports. Potential confounders (demographics, comorbidities, lifestyle factors, etc.) were considered. A total of 1353 men (mean age 84.2 ± 4.0 years, 92.7% white) were followed for 6.03 ± 2.11 years. In the unadjusted (continuous) model, there were no interactions (p > 0.05) between any muscle variable (D3 Cr muscle mass, muscle volume, muscle density, grip strength or leg force) and Tt.BMD at distal radius/tibia for fractures (all: n = 182-302; nonvertebral: n = 149-254; vertebral: n = 27-45). No consistent interactions were observed when interchanging Tt.BMD for Tb.BMD/Ct.BMD or for Ct.Ar (bone structure) at the distal radius/tibia in the unadjusted (continuous) models. Compared with men in quartiles (Q) 2-4 of D3 Cr muscle mass and Q2-4 of distal tibia Tt.BMD, men in Q1 of both had increased risk for all fractures (hazard ratio (HR) = 2.00; 95% confidence interval [CI] 1.24-3.23, p = 0.005) and nonvertebral fractures (HR = 2.10; 95% CI 1.25-3.52, p < 0.001) in the multivariable-adjusted model. Confidence intervals overlapped (p > 0.05) when visually inspecting other quartile groups in the multivariable-adjusted model. In this prospective cohort study of older men, there was no consistent interactions between bone and muscle variables on fracture risk. Larger sample sizes and longer follow-up may be needed to clarify if there is an interaction between bone and muscle on fracture risk in men. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

CO209 Association between Baseline Bone Mineral Density Testing and the Risk of Fractures in Men Initiating Androgen Deprivation Therapy: Population-Based Study

Androgen deprivation therapy (ADT) is a staple of advanced prostate cancer (PCa) treatment, however several side-effects are associated with its long-term use. Notably, loss of bone mineral density (BMD) is accelerated which increases fracture risk. Although guidelines recommend BMD testing when initiating ADT to properly assess baseline fracture risk, there is scarce data to support this recommendation in the PCa patient population. The objective was to examine the association between baseline BMD testing (bBMDT) and the risk of fractures in men initiating ADT for PCa.

Effects of prolactin excess and treatment with cabergoline on bone mineral density and fracture risk in men

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Effect of adipokine and ghrelin levels on BMD and fracture risk: an updated systematic review and meta-analysis.

Circulating adipokines and ghrelin affect bone remodeling by regulating the activation and differentiation of osteoblasts and osteoclasts. Although the correlation between adipokines, ghrelin, and bone mineral density (BMD) has been studied over the decades, its correlations are stillcontroversial. Accordingly, an updated meta-analysis with new findings is needed. This study aimed to explore the impact of serum adipokine and ghrelin levels on BMD and osteoporotic fractures through a meta-analysis. Studies published till October 2020 in Medline, Embase, and the Cochrane Library were reviewed. We included studies that measured at least one serum adipokine level and BMD or fracture risk in healthy individuals. We excluded studies with one or more of the following: patients less than 18 years old, patients with comorbidities, who had undergone metabolic treatment, obese patients, patients with high physical activities, and a study that did not distinguish sex or menopausal status. We extracted the data that include the correlation coefficient between adipokines (leptin, adiponectin, and resistin) and ghrelin and BMD, fracture risk by osteoporotic status from eligible studies. A meta-analysis of the pooled correlations between adipokines and BMD was performed, demonstrating that the correlation between leptin and BMD was prominent in postmenopausal women. In most cases, adiponectin levels were inversely correlated with BMD. A meta-analysis was conducted by pooling the mean differences in adipokine levels according to the osteoporotic status. In postmenopausal women, significantly lower leptin (SMD = -0.88) and higher adiponectin (SMD = 0.94) levels were seen in the osteoporosis group than in the control group. By predicting fracture risk, higher leptin levels were associated with lower fracture risk (HR = 0.68), whereas higher adiponectin levels were associated with an increased fracture risk in men (HR = 1.94) and incident vertebral fracture in postmenopausal women (HR = 1.18). Serum adipokines levels can utilize to predict osteoporotic status and fracture risk of patients. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021224855, identifier CRD42021224855.

Fracture Risk in Men and Women With Vertebral Fractures Identified Opportunistically on Routine Computed Tomography Scans and Not Treated for Osteoporosis: An Observational Cohort Study.

Vertebral fractures (VFs) have been associated with future fractures, yet few studies have evaluated whether this pertains to VFs available for identification on routine radiological imaging. We sought to evaluate the risk of subsequent fractures in subjects with VF identified opportunistically on computed tomography (CT) scans performed as part of routine clinical practice. From the radiology database of Holbæk Hospital we identified the first CT scan including the thorax and/or abdomen of 2000 consecutive men and women aged 50 years or older, performed from January 1, 2010 onward. The scans were assessed in a blinded approach to identify chest and lumbar VF, and these data linked to national Danish registers. Subjects were excluded if treated with an osteoporosis medication (OM) in the year prior to baseline (date of CT), and the remaining subjects with VF matched on age and sex in 1:2 ratio against subjects with no VF. We found that the risk of major osteoporotic fractures (hip, non-cervical vertebral, humerus, and distal forearm fractures) was higher for subjects with VF than without VF: incidence rates (IRs) were 32.88 and 19.59 fractures per 1000 subject-years, respectively, and the adjusted hazard ratio (HRadj) was 1.72 (95% confidence interval [CI], 1.03-2.86). Subsequent hip fracture IRs were 16.75 and 6.60; HRadj 3.02 (95% CI, 1.39-6.55). There were no significant differences in other fracture outcomes (including a pooled estimate of any subsequent fracture, except face, skull, and fingers: IRs 41.52 and 31.38; HRadj 1.31 [95% CI, 0.85-2.03]). Our findings suggest that subjects undergoing routine CT scans including the chest and/or abdomen are a high risk population in terms of fracture risk. Even within this group, subjects with VF are at higher risk of future major osteoporotic fracture (MOF), in particular hip fracture. Hence, systematic opportunistic screening for VF and subsequent fracture risk management is important to reduce the risk of new fractures. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

OR01-3 Lack of Bone Mineral Density Testing in Men with Hypogonadism: A Clinical Conundrum

Abstract Objective Hypogonadism is a known risk factor for decreased bone mineral density (BMD) and increased risk of fractures in men. The 2012 Endocrine Society Clinical Practice Guidelines recommend that men ≥ 50 years of age with a diagnosis of hypogonadism undergo BMD testing.1 The objective of this study was to determine the frequency at which men aged ≥ 50 with a diagnosis of hypogonadism underwent BMD testing, and among those that underwent testing, the percentage of men diagnosed with osteopenia or osteoporosis and subsequently treated with an osteoporosis medication. Methods A retrospective chart review was conducted using the enterprise-wide electronic health record system at our institution. Inclusion requirements were an ICD-9 or -10 code for hypogonadism at any time between 7/1/2012 and 9/30/2020, and at least two subsequent visits with providers from primary care, endocrinology, or urology. Patients with a diagnosis of osteoporosis or who had undergone treatment with an osteoporosis medication, prior to the diagnosis of hypogonadism, were excluded. Patients were followed until the date of BMD assessment or censoring (9/30/2021). The testing results and documentation of treatment with an osteoporosis medication were recorded. Categorical variables and continuous variables were summarized using N (%) and median (IQR) or mean (SD), respectively. Results A total of 10,169 men with hypogonadism were identified. General characteristics included mean age of 63.4 years (±9.2), 85.2% white, 52.7% with history of smoking, 68.2% with hypertension, 36.9% with type 2 diabetes, and mean BMI of 31.3 kg/m2 (±6.0). Median follow-up time was 6.6 years (3.8, 8.5). Of 728 (7.2%) patients who underwent BMD testing, 352 (48.4%) had osteopenia and 87 (12.0%) had osteoporosis. A total of 5,633 (55.4%) men underwent treatment with testosterone replacement therapy. Of the 87 patients identified as having osteoporosis, 50 (57.5%) were treated with an osteoporosis medication. Conclusion Despite a recommendation from the 2012 Endocrine Society for men ≥ 50 years of age with hypogonadism to undergo BMD testing, the rate at which this testing is performed in real-world practice is quite low. The high rate (60.3%) at which low BMD was discovered in hypogonadal men who underwent testing, and further observation of a low rate of treatment with osteoporosis medication when indicated, is alarming and necessitates a call to action for more hypogonadal men to undergo testing and receive appropriate treatment. Further studies are needed to determine the reasons why so few men with hypogonadism undergo BMD assessment and what systems can be put in place to overcome this clinical conundrum. Reference 1. Watts NB, et al. Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology &amp; Metabolism, Volume 97, Issue 6, 1 June 2012, Pages 1802–1822, https://doi.org/10.1210/jc.2011-304 Presentation: Saturday, June 11, 2022 12:00 p.m. - 12:15 p.m.

Reduced trabecular bone mineral density and thinner cortices in men with distal forearm fractures.

Men with distal forearm fractures have reduced bone density, an increased risk of osteoporosis and of further fractures. The aim of the study was to investigate the structural determinants of these observations using quantitative CT (qCT). Ninety six men with low-trauma distal forearm fracture and 101 age-matched healthy control subjects were recruited. All subjects underwent a quantitative CT on a standard 64-slice whole body CT scanner. These were analysed on Mindways QCT PRO™ Software to generate volumetric and geometric data at the lumbar spine, femoral neck and total hip, ultra-distal and distal 33% radius. Biochemical investigations, health questionnaires and measurements of bone turnover were made. Men with fracture had significantly lower total and trabecular vBMD at all sites. The greatest percentage reduction was at the ultra-distal radius (13.5% total and 11.7% trabecular vBMD). In the fracture group cortical vBMD was significantly higher in the femoral neck (p<0.001) and maintained at the ultra-distal radius compared with control subjects. However, cortical cross-sectional area (CSA) and thickness were significantly reduced at the femoral neck (p<0.001 and p=0.002 respectively) and forearm sites (CSA ultradistal radius p=0.001, cortical thickness p=0.002, CSA distal one third radius p=0.045 and cortical thickness p=0.005). Cross sectional moment of inertia (CSMI) and section moduli were significantly reduced at the femoral neck (CSMI1 p=0.002, CSMI2 p=0.012 and section moduli Z1 p<0.001, Z2 p=0.004) and the ultra-distal radius (CSMI1 p=0.008 and section moduli Z1 p=0.018, Z2 p=0.007). In stepwise logistic regression analysis distal forearm fracture showed the strongest association with a model comprising ultra-distal forearm trabecular vBMD (negative), procollagen type I N-terminal propeptide (PINP, positive) and sex hormone binding globulin (SHBG, negative). In conclusion, these observations explain the structural reasons for the increased fracture risk in men with distal forearm fractures.