Author/Editor		Zavratnik, Andrej
Title		Osteoporoza pri moškem
Translated title		Osteoporosis in men
Type		članek
Source		In: Monografija IV. osteoloških dnevov z mednarodno udeležbo Maribor : Univerzitetni klinični center
Publication year		2013
Volume		str. 151-160
Language		slv
Abstract		Osteoporza (OP) je pomemben vzrok obolevnosti in smrtnosti pri moških, ki pa je pred nastankom zloma in pogosto tudi po njem nediagnosticirana in nezdravljena. Znano je, da moški utrpijo 1/3 vseh zlomov kolka in pomemben del vseh zlomov vretenc širom po svetu ter da je umrljivost moških v primerjavi z ženskami po obeh tipih OP zlomov pomembno večja. Razlike v rasti, mikroarhitekturi in kopnenju kosti ter tveganju za zlom so posledica razlik v ravneh spolnih hormonov in njihovem učinku na kosti. Čeprav je testosteron (T) glavni moški spolni hormon pa so rezultati raziskav potrdili, da ima v preprečevanju OP pri moških, podobno kot pri ženskah, najpomembnejšo vlogo bioraspoložljivi estrogen (E). Le ta primarno nastane v procesu aromatizacije androgenov v estrogene v perifernih tkivih. Farmakološko zdravljenje potrebujejo moški z velikim tveganjem za OP zlom. V skladu z novimi slovenskimi smernicami so to v prvi vrsti bolniki po OP zlomu vretenca ali kolka. Večino ostalih z velikim tveganjem za zlom lahko identificiramo s pomočjo računalniškega algoritma FRAX, ali na podlagi meritve mineralne kostne gostote, pri čemer je pri interpretaciji izvida potrebno upoštevati starost. Moške s primarno OP zdravimo z bisfosfonati, stroncij ranelatom in teriparatidom. Moškim s hipogonadizmom lahko koristi nadomeščanje testosterona, ki ga dodamo k prej omenjenim temeljnim zdravilom za OP. Če gre za moške zdravljene z antiandrogenimi zdravili in v primeru kostnih metastaz solidnih tumorjev lahko uporabimo denosumab.Osteoporosis (OP) before and even after fracture remains an underdiagnosed and undertreted cause of morbidity and mortality in men. It is well known that 1/3 of all hip fractures and important part of vertebral fractures worldwide occuring in men with greater mortality rate after both type of fractures compared with women. Differences in growth, microarhitecture, and bone loss as well as risk of fractures depends on different sex steroid levels and actions. Although testosteron (T) is predominant male sex steroid, evidence indicates that levels of bioavailable estorgens (E) rather then T are the most important in preventing OP in men as well in women. The main source of E is aromatization of androgens in periferal tissue. Pharmacologic therapy to reduce fracture risk is advisable for men with high risk for fractures. According to new Slovenian guidelines primarily, patients after OP vertebral or hip fracture must be treated, while the majority of other men at risk can be identified using a fracture risk assessment tool FRAX. The measurement of bone mineral density could also be used, but in this case we have to take into account the age of the man. Bisphosphonates, strontium ranelate and teriparatide are approved therapeutic options for primary OP, while testosterone replacement could help in men with hypogonadism as addition to previously mentioned basic treatment. In case of androgen depriviation therapy and in case of solid bone metastases denosumab can be used as well.
Keywords		osteoporoza moški spolni hormoni zdravljenje z zdravili osteoporosis men sex steroid pharmacologic therapy