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Osteoporos Int. 2009 Apr;20(4):507-18. doi: 10.1007/s00198-008-0720-1. Epub 2008 Aug 29.

Risk factors for low BMD in healthy men age 50 years or older: a systematic review.

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Division of Geriatric Medicine, Department of Medicine, McMaster University, Ontario, Canada.



In this systematic review, we summarize risk factors for low bone mineral density and bone loss in healthy men age 50 years or older. Consistent risk factors were: age, smoking, low weight, physical/functional limitations, and previous fracture. Data specific to men has clinical and policy implications.


Osteoporosis is a significant health care problem in men as well as women, yet the majority of evidence on diagnosis and management of osteoporosis is focused on postmenopausal women. The objective of this systematic review is to examine risk factors for low bone mineral density (BMD) and bone loss in healthy men age 50 years or older.


A systematic search for observational studies was conducted in MEDLINE, Cochrane Database of Systematic Reviews, DARE, CENTRAL, CINAHL and Embase, Health STAR. The three main search concepts were bone density, densitometry, and risk factors. Trained reviewers assessed articles using a priori criteria.


Of 642 screened abstracts, 299 articles required a full review, and 25 remained in the final assessment. Consistent risk factors for low BMD/bone loss were: advancing age, smoking, and low weight/weight loss. Although less evidence was available, physical/functional limitations and prevalent fracture (after age 50) were also associated with low BMD/bone loss. The evidence was inconsistent or weak for physical activity, alcohol consumption, calcium intake, muscle strength, family history of fracture/osteoporosis, and height/height loss.


In this systematic review, we identified several risk factors for low BMD/bone loss in men that are measurable in primary practice.

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Conflict of interest statement

Conflicts of interest Alexandra Papaioannou, MD, FRCPC, MSc Consulting and Advisory Role: Amgen, Eli Lilly, Merck Frosst, Novartis, Proctor & Gamble, Sanofi-aventis, Servier Clinical Trials: Amgen, Eli Lilly, Merck, Novartis, Proctor & Gamble, Sanofi-aventisAnn Cranney, MD, FRCPC, MSc has received honoraria for educational lectures from Merck Frosst, Alliance for Bone Health and Novartis; and consultant fees from Amgen Canada and Research funding from Hofmann La Roche.Jacques P. Brown, MD, FRCPC has received honoraria for lecturing, consultancies, grants and research support for clinical trials: Abbott, Alpharx, Amgen, Arthrolab, Sanofi-aventis Canada, Boehringer Ingelheim/Roche, Bristol-Myers Squibb, Celltech, Eli Lilly Canada, Genizon, Glaxosmithkline, Merck Frosst, Nicox, Novartis, NPS Pharma, Pfizer, Proctor & Gamble, Quintiles, Rhône-Poulenc Rorer, Servier, Wyeth, Zelos.Stephanie M Kaiser, MD, FRCPCAdvisory Boards: Amgen, Eli Lilly, Novartis, Wyeth-Ayerst, ServierSpeaker for: Amgen, Eli Lilly, Novartis, Merck, Procter & Gamble/Sanofi-aventis, AstraZeneca, ServierWilliam D. Leslie, MD, FRCPC, MScSpeaker fees, research honoraria, and unrestricted research grants: Merck Frosst Canada Ltd; research honoraria and unrestricted educational grants from The Alliance for Better Bone Health: Sanofi-aventis and Procter & Gamble Pharmaceuticals Canada, Inc.; unrestricted research grants from Novartis Pharmaceuticals Canada, Inc.; unrestricted educational grants from Genzyme CanadaAliya KhanConsulting Role: Proctor & Gamble, Merck Frosst, NovartisResearch: Proctor & Gamble, Merck Frosst, Servier, Amgen, Eli Lilly Jonathan D. Adachi, MDConsulting Role: Amgen; Astra Zeneca, Eli Lilly; GlaxoSmithKline; Merck Frosst; Novartis; Proctor & Gamble; Roche; Sanofi-aventis; ServierClinical Trials: Eli Lilly; GlaxoSmithKline; Merck; Novartis; Pfizer; Proctor & Gamble; Sanofi-aventis; Servier; Wyeth-AyerstCourtney C. Kennedy, MSc; Gillian Hawker MD, MSc, FRCPC; Anna M. Sawka MD, FRCPC, PhD; Kerry Siminoski, MD, FRCPC; David Webster, MD, FRCP; Jessie McGowan MLIS: No competing interests to declare.

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