SECONDARY CAUSES OF OSTEOPOROSIS IN MEN WITH HIP FRACTURE, IS IT WORTH LOOKING?

Abstract

Introduction Men will account for 30% of hip fractures in the next decade and men have a higher mortality after hip fracture than women. Men with osteoporosis often have secondary aetiological conditions. Our aim was to prospectively define secondary causes of osteoporosis in a group of men presenting with hip fracture.

Methods Forty-two men presenting with hip fracture were prospectively recruited and compared with 19 male controls that had primary hip arthroplasty for osteoarthritis. Bone mineral density (BMD) was measured by DEXA of unaffected hip and spine. Secondary causes of osteoporosis were identified from history and by biochemical and hormonal assays. Bone turnover was assessed by urinary deoxypyridinoline (DPD). Bone biopsy was taken to confirm or exclude osteomalacia.

Results Secondary factors were identified in 86% of hip fracture patients. Eighteen patients (42%) had hypogonadism (serum Testosterone < 7nmol/L), nine (21%) had vitamin D deficiency, thirteen (31%) had elevated parathyroid hormone (PTH), eight (19%) had a history of glucocorticoid use (equivalent prednisolone > 5mg/d), seven (17%) had heavy alcohol intake, and four (9%) had rheumatoid arthritis. Compared with controls, hip fracture patients had lower BMD (p=0.002), higher urinary DPD (p=0.004), lower serum Insulin-like Growth Factor-I (IGF-I) (p=0.02), and elevated PTH (p=0.008).

Conclusions Secondary causes of osteoporosis are common in men with hip fractures. Investigation and treatment of underlying conditions should be part of hip fracture management in men. Low BMD, high bone resorption, high PTH levels, and low serum IGF-I were associated with hip fractures when compared to men with hip osteoarthritis.

In relation to the conduct of this study, one or more of the authors is in receipt of a research grant from a non-commercial source.