Osteoporosis en hombres menores de 65 años manifestada por aplastamiento vertebrales: ¿idiopática o secundaria? / Osteoporosis in men under 65 years old manifested by vertebral squashing: idiopathic or secondary?

RESUMO

Osteoporosis in young or middle age men is unusual and requires an extensive diagnostic work-up. To report a retrospective review of nine men with osteoporosis aged 27 to 61 years old (mean 39), that presented with primary diagnosis of osteoporosis, were reviewed. Subjects were subjected to a diagnostic work-up 5 years after the onset of symptoms. Their body mass index ranged from 21.7 to 26.3 kg-m2, all had vertebral fractures (crush fractures in 8 and a biconcave deformity in one) between T4 and L4 and all had normal serum calcium, phosphate, alkaline phosphatase and cretinine. Four patients had a history of neprholithiasis and 3 had hypercalciuria. Bone density, measured in 7 patients with a dual photon densitometer, showed a mean Z score of -2.0 in the spine and -2.2 in the femoral neck. The final diagnoses of these patients were Cushing's disease in 2, malabsorption syndrome in 1, use of phenobarbital and hydantoin in 1, over renal hypercalciuria with low calcium intake in 1 and alcoholic liver disease in 1. In 3 patients, osteoporosis was considered idiopathic. Of these, 2 had moderate absorptive hypercalciuria as a presumible risk factor. Six of the 9 studied male patients with osteoporosis had an underlying cause and in three, this condition was considered idiopathic