[Osteoporosis in men: epidemiology, physiopathology, diagnosis, prevention and treatment]

This article reviews the most current information about epidemiology, risk factors, diagnosis, prevention and management of male osteoporosis.

Although osteoporosis is often regarded as a disease of women, 30% of osteoporotic fractures occur in men. Risk factors for osteoporosis or fractures in men include previous fragility fractures, maternal history of fragility fracture, hypogonadism, low body mass index, smoking, high alcohol consumption, low calcium intake, corticoid therapy, physical inactivity, and the presence of conditions such as hyperthyroidism, hyperparathyroidism, hypercalciuria or chronic inflammatory diseases. Treatment of osteoporosis is recommended in men aged > 65 years with low bone mass (T-score < -2.5), in men aged 50 to 65 years with low bone mass and at least one risk factor for osteoporosis or fracture, in men aged < 50 years with Z-score < -2 with at least one risk factor for osteoporosis or fracture and in men with at least two fragility fractures.

Further studies are needed to better estimate the benefit of of bisphophonates in the prevention of glucocorticoid-induced osteoporosis and the prevention of androgen-deprivation therapy (treatment of prostate cancer) in men at high-risk for osteoporosis, of parathyroid hormone (1-34) in male primary osteoporosis, and of androgen therapy in men with symptoms (including low bone mineral density) and biological signs (with low blood free testosterone levels) of hypogonadism.