dr.med. Poliklinika Faktor Zdravlje Zagreb, Grad Zagreb, Croatia
Objectives : Male osteoporosis is frequently secondary to androgen deprivation therapy, glucocorticoid use, neurodegenerative diseases, or prolonged inactivity. Degenerative spine changes can artificially elevate lumbar spine BMD on DXA, masking true bone fragility. This pilot study aimed to evaluate the clinical-DXA discordance and functional status in men with secondary osteoporosis referred to a Physical and Rehabilitation Medicine (PRM) outpatient clinic.
Design: Cross-sectional pilot study of 20 men aged ≥60 years with low-energy fractures and/or suspected osteoporosis, each with at least one major secondary risk factor. Assessment included: DXA (lumbar spine, femoral neck, total hip), radiographic spine evaluation, serum 25-OH vitamin D, nutritional assessment (calcium/protein intake), and functional evaluation using Timed Up and Go test, FRAIL questionnaire, and falls history. FRAX scores were calculated where applicable.
Results: Eighteen participants (90%) had at least one fragility fracture, predominantly vertebral. Twelve patients (60%) showed normal or osteopenic lumbar spine DXA values despite marked degenerative changes and meeting clinical osteoporosis criteria. Hip BMD consistently indicated higher fracture risk than lumbar spine measurements. Functionally, 16 patients (80%) had prolonged TUG times ( >12 seconds), 15 (75%) reported falls in the previous year, and 17 (85%) scored in the prefrail/frail range. Vitamin D deficiency (< 30 ng/mL) was present in 14 patients (70%), with 16 (80%) reporting inadequate calcium/protein intake. FRAX underestimated fracture risk in 8 patients (40%), particularly those with neurodegenerative conditions.
Conclusion: Normal lumbar spine DXA values frequently masked true bone fragility in men with secondary osteoporosis. Comprehensive PRM assessment combining functional testing, clinical examination, and nutritional evaluation effectively identified clinical-DXA discordance. Early PRM consultation should be considered for all men with secondary osteoporosis risk factors to ensure timely diagnosis, appropriate pharmacotherapy, and implementation of targeted rehabilitation and fall-prevention strategies.
