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Osteoporosis in older men: discovering when and how to treat it
N A Siddiqui1, K R Shetty, E H Duthie
1Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.
Abstract:
Nearly 1.5 million American men age 65 and older have osteoporosis, and another 3.5 million are at risk. Hip fractures in older men have a higher mortality than in women and represent a growing medical problem. Glucocorticoid treatment, hypogonadism, and excessive alcohol consumption are important secondary etiologies for loss of bone mass in men. Detection of hypogonadism may be difficult, and testosterone replacement is indicated for only a well-defined subset of patients. Because of a lack of data on pathogenesis, risk factors, and therapeutic interventions in men, treatment decisions are usually based on extrapolation from studies in women. None of the medications approved by the FDA for the treatment of osteoporosis in postmenopausal women has been approved for use in older men, but physicians are prescribing bisphosphonates and calcitonin.
Insights
Osteoporosis affects millions of older men, with hip fractures posing a higher mortality risk. Secondary causes like hypogonadism and medication side effects contribute to bone loss in men.
Area of Science:
- Gerontology
- Endocrinology
- Orthopedics
Background:
- Osteoporosis affects 1.5 million men aged 65+, with 3.5 million at risk.
- Hip fractures in older men have higher mortality rates than in women.
- Secondary causes include glucocorticoid treatment, hypogonadism, and alcohol abuse.
Purpose of the Study:
- To highlight the growing problem of osteoporosis in older men.
- To discuss secondary etiologies of bone loss in men.
- To address the lack of specific data and FDA-approved treatments for male osteoporosis.
Main Methods:
- Review of existing literature on male osteoporosis.
- Analysis of secondary causes and diagnostic challenges.
- Examination of current treatment practices and extrapolation from female studies.
Main Results:
- Glucocorticoid treatment, hypogonadism, and excessive alcohol consumption are key secondary causes of bone loss.
- Hypogonadism detection can be challenging, with limited indications for testosterone replacement.
- No FDA-approved osteoporosis medications for men exist, despite physician use of bisphosphonates and calcitonin.
Conclusions:
- Male osteoporosis is an under-researched area with significant health implications.
- Further research is needed on pathogenesis, risk factors, and effective therapeutic interventions for men.
- Current treatment strategies are often based on data from postmenopausal women, necessitating a more tailored approach for men.