Male osteoporosis-what are the causes, diagnostic challenges, and management

Area of Science:

• Gerontology
• Endocrinology
• Orthopedics

Background:

• Osteoporosis affects up to 25% of individuals over 50 experiencing fractures, yet remains underdiagnosed and undertreated in men.
• Bone loss in men is associated with aging and comorbidities, with secondary causes identified in up to 60% of cases.
• Men with major fragility fractures face higher mortality rates compared to women.

Purpose of the Study:

• To highlight the underrecognition and undertreatment of osteoporosis in men.
• To emphasize the diagnostic criteria and treatment considerations for male osteoporosis.
• To underscore the importance of fracture risk assessment and intervention in men.

Main Methods:

• Diagnosis based on low-trauma fractures or bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) T-scores ≤ -2.5.
• Review of clinical trial data, noting that most focused on bone density rather than fracture reduction in men.
• Assessment of fracture risk in the male population.

Main Results:

• Osteoporosis diagnosis in men mirrors that in women, relying on fracture history and DXA T-scores.
• Antifracture efficacy of osteoporosis treatments is less documented in men than in women due to trial endpoint differences.
• Significant mortality risk associated with major fragility fractures in men.

Conclusions:

• Men are at substantial risk for osteoporosis and related fractures, necessitating greater clinical attention.
• Despite diagnostic similarities, treatment efficacy data for fracture reduction in men require further investigation.
• Intervention with osteoporosis treatments is recommended for men identified as high fracture risk.