La salute di Genere in Toscana5 Novembre 2013

Villa la Quiete alle MontalveFirenze

Prof.ssa Maria Luisa BrandiSOD Malattie del Metabolismo Minerale e Osseo

AOUC Firenze

Osteoporosi

VENUS

MARS

Major causes of osteoporosis in men

Adapted from: Endocrinol Metab Clin N Am 36:399, 2007

Adapted from: Osteopor Int 17:337, 2006

Bone Mineral accrual in the University of Saskatchewan TB-BMD study

The data are from the Epidemiological Follow-up Study cohort of the First National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of noninstitutionalized civilians who were followed for a maximum of 22 yr. A cohort of 2879 Caucasian men (1437 in the bone density subsample) aged 45–74 yr at baseline (1971–1975) were observed through 1992

From A. C. Looker et al.: Osteoporosis Int 8:468–489, 1998

Bone Loss Begins in the Third Decade of Life in Both Sexes

IF GENDER SPECIFIC DIFFERENCES IN OSTEOPOROSIS EXIST, HORMONAL

DIFFERENCES BETWEENTHE SEXES COULD ACCOUNT

FOR SUCH DIFFERENCES

Adapted from: JBMR 13:763, 1998

Schematic representation of a UNITARY model for bone loss in postmenopausal women (A) and in aging men (B)

Differences between Men and Women in Periosteal Apposition and Net Bone Loss during Aging

Adapted from: NEJM 24:320,2003

The Unitary Model for Estrogen Deficiency and the Pathogenesis of Osteoporosis: IS REVISION NEEDED?

Estrogen deficiency as the predominant cause of both the early and late phases of bone loss in postmenopausal women and as a contributing cause of the continuous phase of bone loss in aging men

UNITARY

JBMR 13:763, 1998

The pathogenesis of osteoporosis is changing from an estrogen-centric model to one in which bone loss is driven by cell-autonomous age-related factors (largely based on rodent studies)

REVISIONIST VIEW

Endocr Rev 31:265, 2010

Clinical studies using QCT demonstrated that the onset of cortical bone loss in the elderly is closely tied to estrogen deficiency. Conversely, trabecular bone loss begins in young adults of both sexes, as trabecular bone health requires higher estrogen levels for its regeneration (based on humans)

MODIFYING VIEW

JBMR 26:441, 2011

World Osteoporosis Day