Current approaches to the management of osteoporosis in men

The epidemiology, pathophysiology, diagnosis, and management of osteoporosis in men are reviewed.

Men with osteoporosis account for approximately one fifth of all patients with osteoporosis, and their morbidity and mortality rates from this disease are higher than in other patients. Guidelines specifically addressing the management of osteoporosis in men are not available. Lifestyle modifications, including smoking cessation, limited alcohol consumption, routine exercise, and fall prevention strategies, are beneficial to maintain bone health. Appropriate calcium and vitamin D intakes are critical components of any osteoporosis management strategy. Drug therapy should be initiated in all men at high risk for fracture. Alendronate is indicated for the treatment of osteoporosis. It is considered first-line therapy because of its efficacy and safety profiles. Teriparatide is indicated for the management of osteoporosis in high-risk men, but the drug's cost, complex administration schedule, and potential risks have caused it to be restricted to a second-line therapy. Other options reserved for select patients include calcitonin and testosterone. Further studies are needed to better understand the distinctive features and management strategies for men with osteoporosis.

While the rate of osteoporosis in men is lower than in women, the consequences are possibly more devastating. Evaluation of secondary causes, especially hypogonadism, is important, as they can play a significant role in the development of osteoporosis in men. All men should be educated to improve modifiable risk factors and maintain recommended daily intakes of calcium and vitamin D. Bone mineral density should be evaluated in high-risk men using central dual energy x-ray absorptiometry, and drug treatment should be considered in those with a history of low-trauma fracture or significant bone loss.