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山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (6): 5-9.doi: 10.6040/j.issn.1671-7554.0.2021.0467

• 骨质疏松症新进展专题 • 上一篇    下一篇

男性骨质疏松:一个长期被忽视的问题

程晓光1,卢艳慧2   

  1. 1. 北京积水潭医院放射科, 北京 100035;2. 解放军总医院第二医学中心内分泌科, 北京 100853
  • 发布日期:2021-06-10
  • 通讯作者: 程晓光. E-mail:xiao65@263.net
  • 基金资助:
    国家自然科学基金(81771831);北京市自然科学基金(L172019);北京市医院管理中心临床医学发展专项经费(ZYLX202107)

Osteoporosis in men: a chronically overlooked problem

CHENG Xiaoguang1, LU Yanhui2   

  1. 1.Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China;
    2. Department of Endocrinology, Second Medical Center of PLA General Hospital, Beijing 100853, China
  • Published:2021-06-10

摘要: 骨质疏松症是一种全身性骨病。骨量减少和骨微结构破坏使骨的脆性增加,最终导致骨折风险增加。按照病因不同可将原发性骨质疏松分为绝经后骨质疏松(PMO)和老年性骨质疏松(SO)。而男性骨质疏松主要为SO,所以男性比女性发病晚。目前骨质疏松诊断主要依据双能X线吸收法(DXA)的T值及DXA的流调结果,显示男性骨质疏松患病率低,因此受到重视不够。另外,目前治疗骨质疏松的药物男性适应证少,造成对男性的骨质疏松防治的忽视。所以应该采用多种检测手段,包括影像检查、DXA和定量CT(QCT)对骨质疏松进行诊断,以及加强人们对男性骨质疏松的认知和对干预的重视。

关键词: 骨质疏松, 男性, 双能X线吸收法, 定量化CT, 抗骨质疏松治疗

Abstract: Osteoporosis is a systemic bone disease. The loss of bone mass and the destruction of bone microstructure increase bone fragility and ultimately lead to an increased risk of fracture. According to etiology, primary osteoporosis can be divided into postmenopausal osteoporosis(PMO)and senile osteoporosis(SO). Osteoporosis in men is mainly SO, so the onset of osteoporosis in men is later than that in women. Due to the current dependence on dual X-ray absorptiometry(DXA)in the diagnosis of osteoporosis and the survey results of DXA, the prevalence of osteoporosis in men is considered low. In addition, there are few indications of drugs for the treatment of osteoporosis in men, resulting in the overlook of the prevention and treatment of osteoporosis in men. Therefore, it is necessary to increase the application of various testing methods, including radiology, DXA and QCT in the diagnosis of osteoporosis, as well as strengthen the awareness of osteoporosis in men and its intervention.

Key words: Osteoporosis, Male, Dual X-ray absorptiometry, Quantitative computed tomography, Anti-osteoporosis therapy

中图分类号: 

  • R574
[1] Kanis JA, Melton LJ 3rd, Christiansen C, et al. The diagnosis of osteoporosis[J]. J Bone Miner Res, 1994, 9(8): 1137-1141.
[2] 中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊疗指南(2017)[J].中华骨质疏松和骨矿盐疾病杂志, 2017, 10(5): 413-414.
[3] Zeng Q, Li N, Wang Q, et al. The prevalence of osteoporosis in China, a nationwide, multicenter DXA survey[J]. J Bone Miner Res, 2019, 34(10): 1789-1797.
[4] 程晓光,董剩勇,王亮,等.应用双能X线骨密度仪调查中国人群骨密度水平和骨质疏松症患病率[J].中华健康管理学杂志, 2019, 13(1): 51-58.
[5] 中华医学会骨质疏松和骨矿盐疾病分会.男性骨质疏松症诊疗指南[J].中华骨质疏松和骨矿盐疾病杂志, 2020, 13(5): 381-395.
[6] Berger C, Goltzman D, Langsetmo L, et al. Peak bone mass from longitudinal data: implications for the prevalence, pathophysiology, and diagnosis of osteoporosis [J]. J Bone Miner Res, 2010, 25(9): 1948-1957.
[7] Si L, Winzenberg TM, Jiang Q, et al. Projection of osteoporosis-related fractures and costs in China: 2010-2050[J]. Osteoporos Int, 2015, 26(7): 1929-1937.
[8] Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures[J]. BMJ, 1993, 307(6914): 1248-1250.
[9] 中华医学会放射学分会骨关节学组,中国医师协会放射医师分会肌骨学组,中华医学会骨科学分会骨质疏松学组,等.骨质疏松的影像学与骨密度诊断专家共识[J].中华放射学杂志, 2020, 54(8): 745-752.
[10] Gao C, Xu Y, Li L, et al. Prevalence of osteoporotic vertebral fracture among community-dwelling elderly in Shanghai[J]. Chin Med J(Engl), 2019, 132(14): 1749-1751.
[11] Wáng YXJ, Che-Nordin N, Deng M, et al. Osteoporotic vertebral deformity with endplate/cortex fracture is associated with higher further vertebral fracture risk: the Ms. OS(Hong Kong)study results[J]. Osteoporos Int, 2019, 30(4): 897-905.
[12] Wang L, Ran L, Zha X, et al. Adjustment of DXA BMD measurements for anthropometric factors and its impact on the diagnosis of osteoporosis[J]. Arch Osteoporos, 2020,15(1): 155. doi: 10.1007/s11657-020-00833-1.
[13] Xu XM, Li N, Li K, et al. Discordance in diagnosis of osteoporosis by quantitative computed tomography and dual-energy X-ray absorptiometry in Chinese elderly men[J]. J Orthop Translat, 2018, 18: 59-64. doi: 10.1016/j.jot.2018.11.003.
[14] Cheng X, Zhao K, Zha X, et al. Opportunistic screening using low-dose CT and the prevalence of osteoporosis in China: a nationwide, multicenter study[J]. J Bone Miner Res, 2021, 36(3): 427-435.
[15] Schousboe JT, Ensrud KE. Opportunistic osteoporosis screening using low-Dose computed tomography(LDCT): promising strategy, but challenges remain[J]. J Bone Miner Res, 2021, 36(3): 425-426.
[16] The Lancet Diabetes Endocrinology. Osteoporosis: overlooked in men for too long[J]. Lancet Diabetes Endocrinol, 2021, 9(1):1. doi:10.1016/S2213-8587(20)30408-3.
[17] Madeo B, Zirilli L, Caffagni G, et al. The osteoporotic male: overlooked and undermanaged? [J]. Clin Interv Aging, 2007, 2(3): 305-312.
[18] Porcelli T, Maffezzoni F, Pezzaioli LC, et al. Male osteoporosis: diagnosis and management-should the treatment and the target be the same as for female osteoporosis? [J]. Eur J Endocrinol, 2020, 183(3): R75-R93.
[19] Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community[J]. Cochrane Database Syst Rev, 2012, 12(9): CD007146. doi:10.1002/14651858. CD007146.pub3.
[20] Kukuljan S, Nowson CA, Sanders KM, et al. Independent and combined effects of calcium vitamin D3 and exercise on bone structure and strength in older men: an 18-month factorial design randomized controlled trial[J]. J Clin Endocrinol Metab, 2011, 96(4): 955-963.
[21] Allison SJ, Folland JP, Rennie WJ, et al. High impact exercise increased femoral neck bone mineral density in older men: a randomised unilateral intervention[J]. Bone, 2013, 53(2): 321-328.
[22] Boonen S, Reginster JY, Kaufman JM, et al. Fracture risk and zoledronic acid therapy in men with osteoporosis[J]. N Engl J Med, 2012, 367(18): 1714-1723.
[23] Orwoll E, Ettinger M, Weiss S, et al. Alendronate for the treatment of osteoporosis in men[J]. N Engl J Med, 2000, 343(9): 604-610.
[24] Ringe JD, Dorst A, Faber H, et al. Alendronate treatment of established primary osteoporosis in men: 3-year results of a prospective, comparative, two-arm study[J]. Rheumatol Int, 2004, 24(2): 110-113.
[25] Boonen S, Orwoll ES, Wenderoth D, et al. Once-weekly risedronate in men with osteoporosis: results of a 2-year, placebo-controlled, double-blind, multicenter study[J]. J Bone Miner Res, 2009, 24(4): 719-725.
[26] Ringe JD, Farahmand P, Faber H, et al. Sustained efficacy of risedronate in men with primary and secondary osteoporosis: results of a 2-year study[J]. Rheumatol Int, 2009, 29(3): 311-315.
[27] Orwoll E, Teglbjærg CS, Langdahl BL, et al. A randomized, placebo-controlled study of the effects of denosumab for the treatment of men with low bone mineral density[J]. J Clin Endocrinol Metab, 2012, 97(9): 3161-3169.
[28] Langdahl BL, Teglbjærg CS, Ho PR, et al. A 24-month study evaluating the efficacy and safety of denosumab for the treatment of men with low bone mineral density: results from the ADAMO trial[J]. J Clin Endocrinol Metab, 2015, 100(4): 1335-1342.
[29] Orwoll ES, Scheele WH, Paul S, et al. The effect of teriparatide [human parathyroid hormone(1-34)] therapy on bone density in men with osteoporosis[J]. J Bone Miner Res, 2003, 18(1): 9-17.
[30] Kaufman JM, Orwoll E, Goemaere S, et al. Teriparatide effects on vertebral fractures and bone mineral density in men with osteoporosis: treatment and discontinuation of therapy[J]. Osteoporos Int, 2005, 16(5): 510-516.
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