The study was carried out in Ankara. Patients were enrolled into the study from the outpatient department of Physical Medicine and Rehabilitation Clinic of the Diskapi Yildirim Beyazit Education and Research Hospital. One-hundred and ninety-three healthy men, who have admitted for various reasons, aged between 35-65 years old were recruited to the study. All of them voluntarily participated in the study. Patients were interviewed using a questionnaire which included variables such as age, weight, height, formal education status of patients, co-morbidity that might cause osteoporosis (i.e., endocrine disorders like hyperthyroid, hypothyroid, hyperparathyroid diseases, or hyperprolactinemia, etc.) and as well as for malignancy or rheumatological or neurological diseases, and medications that affect bone metabolism (anticonvulsants, diuretics, thyroid hormone, corticosteroids, heparin, warfarine, methotrexate, and cyclosporine), smoking history, physical activity and calcium intake. The subjects who use calcium or vitamin D supplementation for any reason; and current or past history for anti-osteoporotic drugs were excluded from the study. We have grouped patients according to the smoking history; non-smokers and smokers. Never smokers and ex-smokers who have not smoked for the last two years have been recorded as non-smokers. The amount of cigarette smoking was calculated by this formula: Number of cigarette packets smoked daily* the number of years = n packet/years. Physical activity has been classified as follows; sedentary that means they didn't do any exercises, they were only active at home, mild physical activity that means they walk 30 minutes everyday, excessive physical activity means they do weight bearing exercises. Calcium intake was assessed semiquantitavily (never, sometimes, everyday) from reported current consumption of each of these foods: milk (more than 250 ml), cheese (more than 50g) and yogurt (more than 125 g). Alcohol consumption was assessed semiquantitavily (never, less than once a month, once or twice a month, twice a week, three or four times a week, everyday) from reported current consumption. Body mass index (BMI) was calculated in kg/m
2. Body mass index (BMI) was categorized according to WHO criteria as underweight (BMI 18.49 kg/ m
2), normal (BMI between 18.5 and 24.9 kg/ m
2), overweight (BMI 25-29.9 kg/ m
2), and obese (BMI 30 kg/ m
2). Lateral and anterior/posterior thoracic and lumbar radiographics of the study participants were taken. Their history of low-trauma fracture was obtained. Low-trauma fracture was defined as a fracture occurring from a trivial/minor injury. They then enquired as to how it had occurred. It was only included if it occurred from low-trauma injuries. Fractures such as those sustained as result of a car accident or fall from a major height were excluded.
BMD was measured from hip (femur neck, trochanter, total) and lumbar spine (L1,2,3,4 and total) by DEXA (Hologic QDR 4900W, Hologic Inc., Bedford, Massachusetts, USA), which has a mean precision error of 1% for the lumbar spine and hip. Values for results of DEXA measurements were expressed as BMD (g/cm2) and T score of young adult healthy reference population, as supplied by the manufacturer because there is still no internationally accepted consensus for osteoporosis in men. The results were recorded as g/cm2 and T score. T scores >-1 SD were classified as normal, the T scores ≤-1 SD were classified as low BMD3. 1) Men whose T score 0 to -1 Standard Deviation (SD) on L1-4 or femur neck or total femur were accepted as men with normal BMD; 2) Individuals with T score in these regions between -1 SD and -2.5 SD were accepted as osteopenic men; 3) Individuals whose T score on L1-4 or femur neck or total femur were less than -2.5 SD were accepted as osteoporotic men. Laboratory; Fasting blood samples were collected in the morning between 08:00 and 09:00 from all subjects. Routine biochemical parameters including sodium, potassium, calcium, phosphorus, creatinine, transaminases, cholesterol, triglycerides, serum magnesium (Mg) were determined by standard laboratory techniques. Serum osteocalcin (OC), total estradiol (E), testosterone (T), growth hormone (GH), parathyroid hormone (PTH) and 25 (OH) vitamin D2 levels were determined using commercially available radioimmunoassay kits. SPSS for Windows 12.0 package statistical software (SPSS Inc., Chicago, IL) was used in the statistical analysis. All measurements were given as mean -SD. Comparisons among groups were analyzed using one-way analysis of variance (ANOVA). Predictors of lumbar spine and hip BMD were determined using logistic regression analysis. The independent variables entered in the regression model were; age; body mass index (BMI); smoking history; alcohol intake; calcium consumption and serum concentrations of 25 (OH) vitamin D2, osteocalcin, parathyroid hormone (PTH), total estradiol, testosterone, growth hormone, cholesterol and magnesium. Statistical significance level was set to 0.05.
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