男性骨質疏鬆症

Male Osteoporosis

據統計男性一生中有大約五分之一會罹患骨質疏鬆症。老年男性骨質疏鬆性髖骨骨折後三個月內的死亡率是同齡的7.85 倍，一年內死亡率可達18-22%。男性骨質疏鬆症的盛行率因調查年齡或研究地區而異，約介於17-40%。次發性原因約佔60%，其中最常見的三大原因有長期使用類固醇、性腺功能低下及飲酒過量，然而鈣與維生素D 的攝取不足也扮演重要角色。利用台灣版十年骨折風險計算工具（fracture risk assessment tool, FRAX®）來篩檢骨折高風險的男性為適當的方式。依據共識認為，70 歲以上男性或50-69 歲合併骨質疏鬆症危險因子者宜安排雙能量X 光吸收儀篩檢，同時檢測腰椎及髖骨骨密度兩部位，取測出較低T 值的部位，並參照世界衛生組織診斷標準予以評估。目前台灣衛生署已通過alendronate、teriparatide、zoledronic acid 及strontium ranelate 四種治療藥物可以使用於男性骨質疏鬆症。本文主要依據最新台灣成人骨質疏鬆症指引並同時列出美國內分泌學會的臨床共識以供臨床參考。

About one fifth of adult males would be suffered from osteoporosis in lifetime. The relative hazard for all-cause mortality in the first 3 months after hip fracture was 7.95 in old men and the one-year mortality rate is 18-22%. The prevalence of male osteoporosis is around 17-40% in different age group and study regions. More than 60% were secondary osteoporosis. Of which, the first three common causes were long-term usage of steroids, hypogonadism and excess alcohol. However, the inadequate intake of calcium or vitamin D can't be overlooked. It is appropriate to use FRAX to find out the males with high fracture risk. The consensus recommends a men aged 70 and above or aged 50-69 with more than one risk of fracture to received dual-energy X-day absorptiometry examination, including both lumbar and hip bone mineral density, and be evaluated by using the lowest T-score following the World Health Organization diagnosis criteria. In Taiwan, four regimens including alendronate, teriparatide, zoledronic acid and strontium ranelate had the license for the treatment of male osteoporosis. This review was based on the newest osteoporosis guideline in Taiwan and the consensus of America Endocrine Society clinical practice guideline to provide the practical viewpoint in clinical practice.