Men's Osteoporosis Support GroupMen's T-score at vertebral fracture point Clin Exp Rheumatol. 2008 Mar,Apr;26(2):283-287. Men suffer vertebral fractures with similar spinal T-scores to women. Del Rio L and others. PMID: 18565250. The World Health Organization (WHO) defines osteoporosis as a BMD (bone mineral density) T-score equal to -2.5 or below the young normal mean for men. Similarly women's osteoporosis is defined in comparison to the young normal mean BMD for women. (See this article for more details on this subject). Since men have larger vertebrae, it was not known if the similar T-scores for men and women would indicate equal fracture risk, thus the purpose of the Del Rio and others study. Of a total of 66946 individuals; 2556 of these subjects had one or more atraumatic vertebral fracture (396 men and 2160 postmenopausal women). When comparing those who had vertebral fractures, the lumbar T-scores were similar for men and women, -2.2 vs. -2.3, respectively. Also a similar percentage of men and women with vertebral fractures had T-score values <-2.5 in the lumbar spine (44% vs. 46%). The authors concluded, " . . .that although men with vertebral fractures have greater vertebral dimensions and BMD than women, the lumbar T-scores are similar. Therefore, it seems reasonable to adopt the same T-score values for the diagnosis of osteoporosis in men and women." Editor's comments: These results are reassuring to men in general who might wonder if their T-score is really indicative of fracture risk. It appears they are, and that using the young adult mean BMD for comparison purposes is correct. Thus males with a T-score of -2.5 or greater should be treated for osteoporosis to reduce the risk of fracture. The database is, however, not corrected for race or ethnicity, so non-white males may not necessarily safely conclude their risk of fracture also conforms to the young adult male BMD mean. At this time there is nothing else to use, so we must hope non-white males have similar risk factors to white males at similar T-scores. Later studies will hopefully shed some light on this question. Note also that the median T-scores of both men and women with vertebral fractures was -2.2 and -2.3, respectively. Additionally, over 50% of the fractures occurred with a T-score greater than -2.5. That means that several individuals fractured at a T-score that would not qualify them for treatment of osteoporosis based solely on BMD. So an individual is still at greater risk than normal of vertebral fracture with a T-score greater than -2.5. Other factors are certainly in play, such as the quality of bone, whether an individual falls or is injured in an accident not involving a fall, etc. Based upon these results it appears that some consideration should be given to raising the T-score value to indicate osteoporosis at, e.g., -2.0 S.D. or similar. Certainly the osteoporosis group should include more than 50% of the fractures in a given study.
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