RESUMEN
UNLABELLED: In this large retrospective study of men with presumed osteoporosis, we estimate the rate of osteoporosis-related fractures in men age ≥30 years. Our results suggest that spine and hip fractures continue to be a considerable disease burden for osteoporotic men of all ages. INTRODUCTION: The purposes of this study were to describe a cohort of men with presumed osteoporosis and estimate the incidence rates of fractures by age. METHODS: Using US administrative claims data, we identified 43,813 men ≥30 years old with an osteoporosis diagnosis or use of an osteoporosis medication. Men were followed for a minimum of 12 months after diagnosis or treatment of osteoporosis (index date), until the earliest of fracture (hip, spine, pelvis, distal femur, humerus, wrist, forearm), disenrollment, or study end date. RESULTS: During the study period, there were 3834 first fractures following the index date and 3303 fractures in the 6-month period prior to the diagnosis/treatment of osteoporosis. Incidence rates of osteoporosis-related fracture, estimated from the index date onward, increased with age, although did not significantly differ from one another in younger age groups (30-49 and 50-64 years). Spine fractures had the highest incidence rate in men across all age groups, increasing from 10.8 per 100,000 person-years (p-yrs) (95% confidence interval (CI) 9.1, 12.7), 12.2 per 100,000 p-yrs (95% CI 11.2, 13.3), and 15.3 per 100,000 p-yrs (95% CI 13.8, 16.9) in men 30-49, 50-64, and 65-74 years to 33.4 per 100,000 p-yrs (95% CI 31.5, 35.4) in men ≥75 years. Hip fractures were the second most common, with the incidence rate reaching 16.2 per 100,000 (95% CI 14.9, 17.6) in the ≥75-year group. CONCLUSION: These incidence rates suggest that spine and hip fractures are a considerable disease burden for men of all ages diagnosed and/or treated for osteoporosis.
Asunto(s)
Osteoporosis/epidemiología , Fracturas Osteoporóticas/epidemiología , Adulto , Distribución por Edad , Anciano , Estudios de Cohortes , Comorbilidad , Fracturas de Cadera/epidemiología , Fracturas de Cadera/etiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Osteoporosis/complicaciones , Fracturas de la Columna Vertebral/epidemiología , Fracturas de la Columna Vertebral/etiología , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: Many patients with Crohn's disease (CD) have low bone mineral density (BMD) that may not be solely attributable to glucocorticoid use. We hypothesised that low BMD in patients with CD is associated with elevated circulating levels of the active form of vitamin D, 1,25-dihydroxyvitamin D (1,25(OH)(2)D). We further hypothesised that this was secondary to increased synthesis of 1,25(OH)(2)D by inflammatory cells in the intestine. The aim of this study was to examine the relationship between 1,25(OH)(2)D levels and BMD in patients with CD. METHODS: An IRB approved retrospective review of medical records from patients with CD (n = 138) or ulcerative colitis (UC, n = 29). Measurements of vitamin D metabolites and immunoreactive parathyroid hormone (iPTH) were carried out. BMD results were available for 88 CD and 20 UC patients. Immunohistochemistry or real time reverse transcription-polymerase chain reaction (RT-PCR) for the enzyme 1alpha-hydroxylase was performed on colonic biopsies from patients with CD (14) or UC (12) and normal colons (4). RESULTS: Inappropriately high levels of serum 1,25(OH)(2)D (>60 pg/ml) were observed in 42% of patients with CD compared with only 7% in UC, despite no differences in mean iPTH. Serum 1,25(OH)(2)D levels were higher in CD (57 pg/ml) versus UC (41 pg/ml) (p = 0.0001). In patients with CD, there was a negative correlation between 1,25(OH)(2)D levels and lumbar BMD (r = -0.301, p = 0.005) independent of therapeutic glucocorticoid use. 1,25(OH)(2)D levels also correlated with CD activity. Lastly, immunohistochemistry and RT-PCR demonstrated increased expression of intestinal 1alpha-hydroxylase in patients with CD. CONCLUSIONS: These data demonstrate that elevated 1,25(OH)(2)D is more common in CD than previously appreciated and is independently associated with low bone mineral density. The source of the active vitamin D may be the inflamed intestine. Treatment of the underlying inflammation may improve metabolic bone disease in this subgroup of patients.
Asunto(s)
Densidad Ósea/fisiología , Enfermedad de Crohn/sangre , Vitamina D/análogos & derivados , Vitamina D/sangre , 25-Hidroxivitamina D3 1-alfa-Hidroxilasa/análisis , Adulto , Colitis Ulcerosa/sangre , Colon/enzimología , Enfermedad de Crohn/enzimología , Femenino , Humanos , Inmunohistoquímica/métodos , Enfermedades Inflamatorias del Intestino/sangre , Masculino , Hormona Paratiroidea/sangre , Reacción en Cadena de la Polimerasa/métodos , Estudios RetrospectivosRESUMEN
Gynecomastia is a common problem during puberty as well as later adulthood, and is caused by hormonal imbalance at the breast tissue level. Various medications and medical conditions can cause gynecomastia and when the drug is discontinued or medical condition cured, it will frequently resolve. Medical therapy can be tried for patients with persistent gynecomastia associated-tenderness or social embarrassment prior to contemplating surgical removal of the breast tissue.