Unresolved issues in osteoporosis in men.

Area of Science:

• Gerontology
• Orthopedics
• Public Health

Background:

• Fragility fractures pose a significant public health challenge in aging men.
• While approximately one-third of hip fractures occur in men, incidence and gender ratios vary globally.
• The underlying causes of higher male mortality post-fracture and differing fracture incidence compared to women require further investigation.

Purpose of the Study:

• To investigate the factors contributing to fragility fractures in men.
• To understand the role of bone mineral density, bone structure, and hormonal influences in male fracture risk.
• To identify knowledge gaps in the prevention and treatment of fractures in men.

Main Methods:

• Review of existing literature on male fragility fractures.
• Analysis of bone mineral density (aBMD) and volumetric bone mineral density (vBMD) data in relation to fracture risk.
• Exploration of potential contributing factors including hypogonadism and bone remodeling processes.

Main Results:

• Areal bone mineral density (aBMD) and prevalent fractures predict fracture risk similarly in men and women.
• Age-specific absolute risks for hip and spine fractures are comparable between sexes for a given aBMD.
• Lower fracture incidence in men may be linked to population distribution of bone size, vBMD, and architecture, alongside higher mortality and fewer falls.

Conclusions:

• The tail end of the male population distribution for bone traits likely accounts for fracture cases.
• Hypogonadism is a risk factor, but its precise definition, prevalence, and structural consequences remain unclear.
• Significant knowledge gaps persist regarding hormonal regulation of bone strength and the mechanisms of bone loss in men.