Gender-Specific Reference Levels Are Needed to Identify Men at Risk of Osteoporotic Fracture, Says University of Pittsburgh Researcher
PITTSBURGH, September 23, 2000 — Just as measures of heart disease in women for years were based on the male cardiovascular model, today doctors are forced to use female-based measures to diagnose osteoporosis in men. Jane Cauley, Dr.P.H., associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health, has conducted research showing that using such female-specific reference values can miss a significant number of osteoporosis cases among men. Dr. Cauley presented her research Saturday, Sept. 23, at the annual meeting of the American Society for Bone and Mineral Research.
"As we age, we all lose bone mineral density, which makes our bones more susceptible to fracture," said Dr. Cauley, principal investigator on the study. "But we’ve found that men fracture at higher levels of bone mineral density than women do."
Because osteoporosis for years has been thought of as a women’s disease, the bone mineral density (BMD) reference values used for judging fracture risk have been based on the female model.
"If doctors use a female-specific cutoff value in diagnosing osteoporosis in men, they could be missing many men who are at risk of fracture," Dr. Cauley continued. "Male-specific reference values should be created and standardized to better identify at-risk men who could benefit from medications that prevent further bone loss."
Dr. Cauley and her research team studied the relationship between BMD and prevalent vertebral fracture in 314 men aged 58-91, and 2,067 women aged 66-95. As expected, fracture increased with age in both men and women. Also, after adjusting for age, weight and height, the mean total hip BMD was lower in men and women with fractures than it was in men and women without fractures.
However, the mean BMD among men with a fracture was significantly higher than the BMD among women with a fracture. Measuring the men’s BMDs against the currently used female-specific cutoff levels identified only three men with fractures, compared with 18 men identified using male-specific cutoff values. Dr. Cauley developed the male cutoff values for the study by evaluating the distribution of BMD among the male subjects.
"It is very important for male-specific reference values to be established and used uniformly in assessing the fracture risk of men," Dr. Cauley said. "As the population continues to age, this policy would mean getting more at-risk men into appropriate therapies to slow or stop the loss of bone before they experience a life-threatening fracture. These interventions would make a big difference in men’s health, just as they have improved women’s health over the past decade."
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