«Accelerated bone loss, but not low periosteal expansion, is associated with higher all-cause mortality in older men - prospective MINOS study»
The paper presented for the review is worthy of great respect and is of great interest.
The problem of osteoporosis has gained particular topicality in the clinical practice within the last 20 years. The earliest researches were mainly devoted to the study of bone loss and bone density loss in females in the period of menopause. However within the last 10 years it has become obvious that in spite of the slightly less prevalence rate of osteoporosis in males the risen bone loss and bone mineral density loss in males will proceed more seriously. And the complications (the fracture of the femor proximity part, in particular) more often, in comparison with females, have a lethal outcome during the first year, and proceed with a greater number of complications in the internal organs. It has to be pointed out that serious fractures in males with osteoporosis happen to occur several years earlier than those in females.
It has also been stated that osteoporosis and osteopenia are more often in males with androgen deficit. The androgen deficit appears to be the main determiner of the bone density loss and bone loss in males.
It’s worth while marking that the problem of osteoporosis is not studied well enough. The proportion of the reviews on this problem is 1 to 10 if compared to the quantity of reviews on osteoporosis in females.
Consequently, the newly appeared researches and analyses are of utmost interest for saving scientific practical information on the problem.
The paper presented here for the review is not an exception.
The important point to be made is that various parts of the long-term prospective study MINOS were published by the authors in the following journals: Osteoporosis International; Annals of Rheumatic Diseases; Journal of Bone and Mineral Research, etc. But the article offered for the review is a new, non- published before material analysis.
The authors presented extremely interesting results, showing the mortality level increase in aged males with the growth of bone mineral density loss, but not because of the low periosteal expansion.
From our point of view the authors came to a very important conclusion: «… It suggests that older men with low BMD or accelerated bone loss should obtain detailed diagnostic assessment to establish general factors which can contribute to their poor bone status».
This is of great clinical importance for the application to the practical activities of doctors. Today most general practitioners don’t perceive the osteoporosis problem as a socially significant illness and orientate themselves only to the possible fractures in the patient’s future. However the given research showed the importance of the bone mineral density loss as it is in the mortality increase in eaged males, by proving that high mortality is associated with the bone mineral density loss, regardless of the fractures.
From our point of view the authors gave convincing proof of this supposition by pointing out that mortality in males increased with the quick loss of the bone mineral density.
Another incontestable value of the work is the carried out analysis of the internal organs diseases, that is: cardiovascular diseases, diabetes mellitus, etc., while the list of the diseases is given by the authors in the description of cohort.
Thus, the presented work is of obvious interest to both the practicing physicians and the scientific community as a completed stage of study of the clinical interconnection between the bone mineral density loss and the general clinical status in aged males.
The research was planned in accordance with the requiremnts to such prospective studies. The selection scope (n=782) is quite enough to form the significant conclusions. The statistical tools of the research are adequate with the use of modern analytical methods.
The presented tables and figures are clear and correspond to the analysis and the material.
There are no comments of principle to the work. However we would like to express our wishes.
Those patients who informed about having the coronary heart disease, arterial hypertension, diabetes mellitus, Parkinson’s disease, cancer of prostate, gastrointestinal diseases, chronic obstructive lung disease, insult, were included into the cohort for the analysis.
The proved causes of the recurrent osteoporosis can be: diabetes mellitus, cancer of prostate, chronic obstructive lung diseases, gastrointestinal diseases. At the same time the coronary heart disease, arterial hypertension, Parkinson’s disease are not the significant risk factor of the recurrent forms of osteoporosis, while, mortality increases in this case due to the presence of these above-mentioned diseases. It would be more logical to present the analysis dividing the cohort of the patients into 2 subgroups with the proved risks of recurrent osteoporosis and without them. That would have certainly ornamented the material and confirmed the importance of the bone mineral density loss, but not the diseases of the internals. Expressing this wish we are doubtlessly aware of the fact that the authors corrected for these diseases while presenting the statistic results, though we believe that a separated analysis could ornament the paper and help to make more distinct practical conclusions.
It would also be desirable that we should have in the discussion part more distinct comparisons of the mortality levels in the patients with the above-mentioned diseases of the internal organs and with the bone mineral density loss and in those without it. That would also help to convince the reader in the necessity of the bone mineral density assessment in aged men.
As a whole, the article is very interesting, is a completed scientific work and can doubtlessly
be presented for the publication in the Journal of Men's Health.