Male osteoporosis

Area of Science:

• Endocrinology
• Geriatrics
• Orthopedics

Background:

• Osteoporosis is often overlooked in men, leading to underdiagnosis and undertreatment.
• Men experience a substantial proportion of fractures, with increased incidence and mortality post-fracture.
• Secondary causes like hypogonadism, alcohol, and glucocorticoids contribute to male osteoporosis.

Purpose of the Study:

• To highlight the underappreciated burden of osteoporosis in men.
• To discuss diagnostic criteria and treatment strategies for male osteoporosis.
• To emphasize the importance of recognizing and managing osteoporosis in the male population.

Main Methods:

• Review of current literature and diagnostic guidelines for male osteoporosis.
• Comparison of osteoporosis diagnosis and treatment in men versus women.
• Evaluation of the role of secondary causes and specific treatments like testosterone replacement therapy.

Main Results:

• Approximately 40% of fractures occur in men, with higher subsequent fracture and mortality risk.
• Only 10% of men with osteoporosis receive adequate treatment.
• International Society for Clinical Densitometry (ISCD) guidelines recommend using female databases for DXA diagnosis (T-score ≤ -2.5).
• Osteoporosis can be diagnosed with fragility fractures or high FRAX scores, independent of bone mineral density (BMD).

Conclusions:

• Male osteoporosis requires greater clinical attention due to its prevalence and severity.
• Diagnostic approaches and treatments largely mirror those for postmenopausal osteoporosis.
• Testosterone replacement therapy can improve BMD in hypogonadal men.