Background/Purpose: Osteoporosis (OP) in males under 70 years is less common than postmenopausal and senile, but generates significant social and health costs associated with morbidity and mortality from fractures. It´s common in patients with inflammatory rheumatic diseases and hepatic, bowel and endocrine pathologies, also in COPD patients and in those undergoing chronic corticosteroid therapy. Sometimes clinical risk factors of male OP go unnoticed, so the diagnosis is delayed and is done when one or more fractures by low energy mechanism have already produced, which is a late diagnosis. Bone Metabolism Unit at Basurto University Hospital receives from 2010 male patients with suspected OP. The objective of this study is to describe demographic and clinical characteristics of men ≤70 years evaluated in our OP consultation, with referral protocols according to risk factors.

Methods: A retrospective, descriptive study based on a review of database of these patients. We analyze origin of derivation, risk factors, presence of fractures at the moment of diagnosis, primary diagnoses and occurrence of refractures. All statistical analyses were performed using SAS for Windows statistical software, version 9.2.

Results: 199 patients, with a mean age of 57.74 years (18-70), from Primary Care (73), and general rheumatology (57), up to 65% of the total; 23 patients (11.5%) from traumatology; 15 from endocrinology (7.5%); 9 from gastroenterology (4.5%). 59.8% were smokers or former smokers, 25% had drinking habit. 20.1% had received prednisone doses ≥ 7.5 mg for more than 3 months. 12 patients had family history of fracture (6%), and 70 already had one or more fractures (35.1%): 57 one or more vertebral fractures, 5 hip fracture and 12 wrist fracture. 99 patients had OP with treatment indication by bone agent. 59.3% had secondary OP, main cause digestive disorders (malabsorption syndromes and inflammatory bowel disease) by 21%, 10% endocrine disorders and rheumatic inflammatory diseases also by 10%. Presence of fractures was associated with decreased DXA spine (p = 0.027) and hip (p = 0.004). A very weak correlation between higher FRAX fracture and number of risk factors was detected, on the other hand a moderate correlation was observed with the number of fractures (Spearman Rho = 0.472; p <0.001). So does to the hip FRAX (Spearman Rho = 0.417; p <0.001). Low levels of D vitamin showed association with decreased DXA in spine. Drinking habit showed statistically significant association (p=0.032) with a decrease in the T – score of hip. Among 70 patients with previous fractures, only 15 (21%) had received prior treatment with bone agent. 7 patients suffered refracture after starting treatment and during follow-up (74.2 months) (6-129).

Conclusion: For the correlation found with spine bone density, it seems important to keep enough D vitamin levels in this population. Almost 1/3 of our patients were referred for low energy mechanism fractures, which is an important failure in early diagnosis, and reveals an unmet need among different specialties of awareness on risk factors for male osteoporosis. Therapy with bone agent (oral biphosphonate mainly), seems useful in preventing new bone fractures in these patients.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/osteoporotic-fracture-as-the-main-risk-factor-in-the-detection-of-osteoporosis-in-men-under-70-years/