Common Questions
What is the appropriate work-up of osteoporosis in men?
Secondary causes of osteoporosis may more often play a role in symptomatic vertebral fractures in men. Fifty percent of men who present with vertebral fracture will have an identifiable secondary cause (1-3). Thus a work-up for secondary causes should be undertaken in all osteoporotic men.
Common secondary causes of osteoporosis include glucocorticoid treatment, hypogonadism, hyperthyroidism, heavy alcohol use, hyperparathyroidism, bone marrow neoplasia, and hypercalciuria (3-8). A reasonable work-up should include (7):
- Serum testosterone
- Thyroid-stimulating hormone (TSH)
- Serum calcium, alkaline phosphatase
- Parathyroid hormone (PTH)
- 25-hydroxy vitamin D
- 24-hour urine calcium
- Complete metabolic panel
- Complete blood count
- Serum and urine protein electrophoresis (SPEP and UPEP)
- Seeman E, Melton LJ 3rd, O'Fallon WM, Riggs BL. Risk factors for spinal osteoporosis in men. Am J Med 1983; 75(6): 977-83.
- Francis RM, Peacock M, Marshall DH, Horsman A, Aaron JE. Spinal osteoporosis in men. Bone Miner 1989; 5(3): 347-57.
- Kelepouris N, Harper KD, Gannon F, Kaplan FS, Haddad JG. Severe osteoporosis in men. Ann Intern Med 1995; 123(6): 452-60.
- Devogelaer JP, DeCooman S, Nagant de Deuxchaisnes C. Low bone mass in hypogonadal males. Effect of testosterone substitution therapy, a densitometric study. Maturitas 1992; 15: 17-23.
- Scane AC, Francis RM, Sutcliffe AM, Francis MJ, Rawlings DJ, Chapple CL. Case-control study of the pathogenesis and sequelae of symptomatic vertebral fractures in men. Osteoporos Int 1999; 9: 91-7.
- Iqbal F, Michaelson J, Thaler L, Rubin J, Roman J, Nanes MS. Declining bone mass in men with chronic pulmonary disease. Chest 1999; 116: 1616-1624.
- Adams JS, Soing CF, Kantorovich V. Rapid recovery of bone mass in hypercalciuric, osteoporotic men treated with hydrochlorothiazide. Ann Intern Med 1999; 130: 658-660.