Background Osteoporosis (OP) in male under 70 years is less common than postmenopausal and senile OP, but causes important social and health costs associated with morbidity and mortality from fractures. It's common in patients with inflammatory rheumatic diseases, enteric and endocrine diseases, also in COPD patients and in those undergoing chronic corticosteroid therapy.
Sometimes clinical risk factors of male OP go unnoticed, so the diagnosis is done when one or more low energy mechanism fractures have already occurred (failure in early detection).
Bone Metabolism Unit at Basurto University Hospital values from years ago male patients referred from different specialties with suspected OP.
Objectives To describe main demographic and clinical characteristics of men aged 70 years or less, visited in our monographic OP consultation, with previous to 2013 protocols established with Primary Care (PC) and rheumatology (derivation according to risk factors).
Methods Retrospective descriptive study based on a review of medical records and database of these patients. We analyze origin of derivation, risk factors, presence of fractures at moment of diagnosis, primary diagnoses and occurrence of refractures.
The analysis was performed using statistical system SPSSv22.
Results 127 patients, mean aged 58.17 years (18–70), up to 74% of the total derived from PC (47), and general rheumatology (47); 10 patients (7.9%) from traumatology; 8 from endocrinology (6.3%); 7 from gastroenterology (5.5%).
55.9% were smokers or former smokers, 22% kept drinking habit. 19.7% had received prednisone doses ≥7.5 mg for more than 3 months.
9 patients had family history of fracture (6.3%), and 46 themselves presented with one or more fractures (36.2%): 36 with one or more vertebral fractures, 4 hip fracture and 12 wrist fracture. 64 patients were diagnosed of OP with treatment indication by bone agent.
61% have secondary OP, the main cause (19%) enteric disorders (malabsorption syndromes and inflammatory bowel disease); 13% endocrine disorders and rheumatic inflammatory diseases by 13%. No primary cause was found in 39% of cases.
The presence of fractures was associated with decreased DXA lumbar spine (p=0.027) and DXA hip (p=0.004). A very weak correlation between higher fracture FRAX 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).
Of the 46 patients with previous fractures, only 12 (26%) had received prior treatment with bone agent. Only 5 patients suffered refracture after starting treatment and during follow-up (94.06 months) (25–129).
Conclusions Almost 1/3 of men were referred for fractures caused by low energy impact, what means a late diagnose of male OP.
It's important to establish protocols with other medical specialties for men at risk to be identified and referred, in order to make an early diagnose.
It highlights the lack of patients derived from pneumologists, although vertebral fractures in chronic respiratory patients worsen their functional status and mean a frequent cause of hospitalization in this group.
Disclosure of Interest None declared