Male osteopenia: a brief review

Recent topics related to testosterone deficiency syndrome in Japan

Androgens, the levels of which decrease with ageing, play many physiological roles in various organs. Testosterone deficiency syndrome (TDS) has received widespread attention in the last several years. First-line treatment for TDS should be testosterone replacement therapy (TRT), which is reported to improve several TDS symptoms. Recently, a clinical practice manual for TDS was written and published by a collaborative team from the Japanese Urological Association and the Japanese Society for the Study of the Aging Male to recommend standard procedures for the diagnosis, treatment, prevention and monitoring of adverse reactions to TRT and for post-treatment assessment. In this manual, intramuscular injection of testosterone enanthate or human chorionic gonadotropin and the testosterone gel 'Glowmin' were recommended as TRT. Currently, two topics related to TDS are being focused on in Japan: the relationship between TDS and metabolic syndrome and treatment options for eugonadal patients with TDS symptoms. In this review, the possibility of TRT for metabolic syndrome as well as the relationship between testosterone and adiponectin, which is a key molecule in metabolic syndrome, is discussed. Finally, the possibility of herbal medicines as a treatment option for patients with TDS is addressed, especially for eugonadal patients, because eugonadal men with TDS symptoms account for approximately 30% of the general population. The increase in the levels of several cytokines, such as IL-8, IL-13, interferon-γ and tumor necrosis factor-α, after herbal medicine treatment may be the reason for this efficacy.

Hypogonadism and androgen replacement therapy in elderly men

The decrease in testosterone levels with age is both central (pituitary) and peripheral (testicular) origin. Because serum levels of sex-hormone-binding globulin increase with aging, the decrease in free testosterone is of even greater magnitude. Recent long-term studies of testosterone therapy in hypogonadal elderly men have shown beneficial effects on bone density, body composition, and muscle strength without any substantial adverse effects on lipids and the prostate. Total testosterone level is the test of choice for initial screening of elderly men who present with signs and symptoms of hypogonadism. If the level is below 300 ng/dL, replacement therapy should be initiated. If the level is normal in a symptomatic patient, free or bioavailable testosterone should be determined. The pros and cons of testosterone therapy should be discussed in depth with every patient, and decisions should be made on an individual basis. This review summarizes the trials of testosterone replacement therapy in elderly men and outlines a diagnostic approach to these patients.

Male menopause. How to define it, how to treat it

There has been a recent explosion of articles in the medical literature and newsbites on television and in the lay press regarding male menopause. Yet, many men are not familiar with the changes in sexuality that accompany aging. Primary care physicians therefore need to be well informed about the concept of male menopause and the dos, don'ts, and unknowns of treating it with testosterone.

Assessing hip fracture risk in a population-based health survey: the NHANES III osteoporosis component

A unique study of osteoporotic hip fracture risk, currently being conducted as part of a national health survey of the United States population, is described. The osteoporosis component of the third National Health and Nutrition Examination Survey (NHANES III) will provide data on multiple risk factors for hip fracture, including bone density of the proximal femur, from a nationally representative sample of adults that includes the very old. The minimum age for inclusion in the component is 20 years, so risk factors can be examined across the adult age range. The component includes men as well as women, and blacks and Mexican Americans as well as non-Hispanic whites. Finally, a longitudinal follow-up of the cohort will allow risk factor data to be related to subsequent hip fracture occurrence.

The impact of socio-medical factors and oral status on dietary intake in the eighth decade of life

The impact of different background factors on dietary intake was studied in a representative sample of 94 men and 89 women (mean age 74.6 years). More women than men in the sample felt lonely, lived alone and felt ill. The women also had more frequent and more severe mandibular dysfunction problems. Many individuals showed an unsatisfactory dietary intake according to the Recommended Dietary Allowance in Sweden (RDA-S). A multivariate analysis showed that sex, age, education, general living conditions, anamnestical and clinical dysfunction indices and dental status influenced dietary intake. Subjective chewing problems were strongly connected with dental status and constituted one of the most important single variables explaining the differences in dietary intake. This study shows the importance of asking elderly patients about their living conditions and chewing problems, as well as evaluating dental status and function from a "masticatory performance perspective" and offering adequate dietary advice.