Osteoporosis in Men: an Overlooked Patient Population
1Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital Boston, Boston, MA, 02115, USA. shchou@bwh.harvard.edu.
Insights
Men experience higher mortality and complications from fractures than women. Despite limited evidence, assessing fracture risk and offering osteoporosis treatment can reduce risks in men.
Area of Science:
- Bone Health
- Geriatric Medicine
- Endocrinology
Background:
- Osteoporosis poses significant risks for men, including higher mortality and complications post-fracture compared to women.
- Men are under-screened for osteoporosis due to factors like limited insurance coverage and insufficient evidence for therapeutic agents.
- Existing research primarily supports vertebral fracture reduction with osteoporosis treatments in men.
Purpose of the Study:
- To outline a management strategy for osteoporosis in men.
- To address the challenges posed by limited clinical evidence in male osteoporosis.
Main Methods:
- Review of current literature on osteoporosis in men.
- Analysis of network meta-analyses and observational studies regarding treatment efficacy.
Main Results:
- Men face greater mortality and morbidity from fractures than women.
- A 2024 study indicated osteoporosis treatment similarly reduces hip fracture risk in men and women.
- Limited evidence primarily confirms vertebral fracture reduction in men.
Conclusions:
- Healthcare providers should proactively assess fracture risk in men.
- Men should be offered opportunities to mitigate osteoporosis-related fracture risks.
- Further research is needed to expand evidence-based osteoporosis management for men.
Purpose Of Review:
The purpose of this review is to describe the approach to osteoporosis management in men in the setting of limited evidence.
Recent Findings:
Although men have less fractures than women, men have greater mortality after fractures as well as increased complications, including infection and major cardiovascular events. Unfortunately, men are not routinely screened for osteoporosis, partially due to limited insurance coverage in the United States. Due to screening barriers and lack of robust evidence of fracture reduction with therapeutic agents in men, treatment rates have also been low. A 2022 network meta-analysis of osteoporosis treatment in men found that with all the randomized controlled trials performed in men, there was only sufficient power to show vertebral fracture reduction. A large case-control observational study from 2024 did find that osteoporosis treatment reduced odds of hip fracture similarly in men and women. Men have fractures, with greater morbidity and mortality than women. Although osteoporosis research is lacking in men, providers should assess fracture risk in men and allow them the opportunity to reduce their fracture risk.
Related Concept Videos
01:29Bone Disorders
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...
01:20Disorders of the Male Reproductive System
Prostate disorders are another major concern. These conditions can impair urinary flow due to the prostate's location around the urethra....
01:28Menopause
01:31Osteoclasts in Bone Remodeling
01:40Bone Remodeling
01:02What is the Skeletal System?