Review of: “Integrating a gender dimension in osteoporosis and fracture research” Piet Geusens & GeertJan Dinant

1. Review of:“Integrating a gender dimension in osteoporosis and fracture research”Piet Geusens & GeertJan Dinant Alan White PhD Professor of Men’s Health Director, Centre for Men’s HealthLeeds Metropolitan University European Men’s Health Forum a.white@leedsmet.ac.uk

2. Impressions of the paper • Congratulations on pulling together many important aspects of gender & osteoporosis. • Excellent consideration of the biological differences. • Identifying the gender perspective proved difficult! Professor Alan White

3. Influences on normal bone development • Over exercise & dietary restrictions in athletes resulting in marked loss of bone mineral density (Bennell et at 1996) • Reduction in manual work for men affecting the build up of reserves of bone density Professor Alan White

4. Co-morbidities • Usage of glucocorticosteroids: eg in lung conditions such as COAD (Vestergaard et al 2005) • Prostate cancer gonadotropin-releasing hormone agonist therapy (Lee et al 2005) • Hypogonadism (Lim & Fitzpatrick 2004) Professor Alan White

5. Impact of lifestyle factors • Higher incidence of alcohol abuse in men, which has a link to loss of bone density • Smoking associated with bone loss, with currently higher incidence of smoking in men, but now an increasing number of young women. Professor Alan White

6. Other gendered factors • Recovery from fractures affected by social isolation (Davidson et al 2003) • Lack of screening for men reduces men’s visibility within the health care service (White & Banks 2004) Professor Alan White

7. Candidacy The gendered impression of osteoporosis reduces the likelihood that both the public and health professionals see men and younger women as possible candidates for the condition (after Davison et al 1991) Professor Alan White

8. Professor Alan White

9. Professor Alan White

10. Conclusion • Changes within society will make osteoporosis more common in both men and women (of all ages). • The causes and the consequences are to a large extent gendered. • Research, policy and practice need to become more gender sensitive and gender aware. Professor Alan White