Osteoporosis in men: a review

Abstract

Osteoporosis and consequent fracture are not limited to postmenopausal women. There is increasing attention being paid to osteoporosis in older men. Men suffer osteoporotic fractures about 10 years later in life than women, but life expectancy is increasing faster in men than women. Thus, men are living long enough to fracture, and when they do the consequences are greater than in women, with men having about twice the 1-year fatality rate after hip fracture, compared to women. Men at high risk for fracture include those men who have already had a fragility fracture, men on oral glucocorticoids or those men being treated for prostate cancer with androgen deprivation therapy. Beyond these high risk men, there are many other risk factors and secondary causes of osteoporosis in men. Evaluation includes careful history and physical examination to reveal potential secondary causes, including many medications, a short list of laboratory tests, and bone mineral density testing by dual energy X-ray absorptiometry (DXA) of spine and hip. Recently, international organizations have advocated a single normative database for interpreting DXA testing in men and women. The consequences of this change need to be determined. There are several choices of therapy for osteoporosis in men, with most fracture reduction estimation based on studies in women.

Marked socioeconomic inequalities in hip fracture incidence rates during the Bone and Joint Decade (2000–2010) in Portugal: age and sex temporal trends in a population based study

“…Frequently, osteoporosis and HF are seen as a woman’s problem and less attention is given to men in both—prevention programmes and drug therapy. In men, drug therapy has never reached the level that it has in women;45 although, with their increasing longevity, more men will be at risk for osteoporosis and HF,43 and interventions must be more inclusive of men.…”

The underlying pathophysiology and therapeutic approaches for osteoporosis

“…Osteoporosis can be classified into two general categories, primary osteoporosis and secondary osteoporosis. Primary osteoporosis is associated with aging and decreased gonadal function while secondary osteoporosis is caused by certain medical conditions or treatment such as hypogonadism, hypercalciuria, hyperparathyroidism, hyperthyroidism, rheumatoid arthritis, and chronic kidney disease etc …”

“…Type 2 osteoporosis, which is also known as senile osteoporosis is found in both sexes. Type 2 osteoporosis is usually characterized by declined bone formation and affects both trabecular and cortical bone …”

Male Hypogonadism and Osteoporosis: The Effects, Clinical Consequences, and Treatment of Testosterone Deficiency in Bone Health

“…Gradually over time, RCTs have emerged in the general male population and demonstrate clear benefits of bisphosphonate therapy on BMD and fracture risk [148, 149]. There have been a number of male bisphosphonate RCTs since the beginning of 2000 that have demonstrated a unanimous improvement in BMD as well as a number of them showing a benefit in fracture risk reduction [146, 147, 150–153].…”