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BMJ 2008; 336 doi: 10.1136/bmj.39576.709444.80 (Published 15 May 2008)
Cite this as: BMJ 2008;336:1096

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Older, thinner men are at risk of osteoporosis

Ann Intern Med2008;148:685-701
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Men get osteoporosis too—particularly those who are over 70, thin (body mass index <20-25), or losing weight, according to a meta-analysis and systematic review of 177 studies in over 28 000 participants. Physical inactivity and a history of fractures were also powerful risk factors for low bone mineral density and further osteoporotic fractures. The authors found a weaker but still potentially important link between osteoporosis in men and alcohol, smoking, and treatment with corticosteroids or androgen deprivation therapy.

A national guideline (p 680) based on these findings says doctors should periodically assess their older male patients for these factors and consider screening those at risk using dual energy x ray absorptiometry (DXA). A close look at 20 studies showed that DXA is the only test supported by decent evidence in men. Compared with this gold standard, calcaneal ultrasound had a sensitivity of only 75%, and a self assessment screening tool based on questions about age and weight had a sensitivity of 81%. A more complex risk score developed by the World Health Organization has been validated only in women.

Supplements to lower homocysteine fail to prevent cardiovascular disease, again

JAMA2008;299:2027-36
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Another large trial, this time in women, has shown that lowering serum concentrations of homocysteine with B vitamins and folic acid does not prevent cardiovascular events. The trial included 5442 professional women with cardiovascular disease or at least three coronary risk factors, compared a combination of vitamin B12, vitamin B6, and folic acid with placebo, and lasted more than seven years—the longest trial to date. Rates of heart attack, stroke, coronary revascularisation, or death from cardiovascular disease were statistically indistinguishable between the two groups (226.9/10 000 person years v 219.2 for the active v placebo groups; relative risk 1.03, 95% CI 0.90 to 1.19).

These results are entirely consistent with other large trials and confirm for women what we …

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