Osteoporosis in men

Osteoporosis in men is a common cause of morbidity, mortality and health care expenditure throughout the Western world. Most cases are secondary to disease or to drug therapy, but in 30-45% of affected individuals no cause can be identified. Research into the factors underlying 'idiopathic' male osteoporosis is limited, but is gradually moving more patients into the 'secondary' category. Recently, attention has focused on interactions between sex hormones and bone: there is evidence that male bone requires both androgens and oestrogens for normal health. Many conditions predispose to osteoporosis in men: hypogonadism, alcohol abuse and the use of corticosteroids are the most frequently identified factors. Osteoporosis following organ transplantation attracts interest despite its relative rarity. Treatment for osteoporotic men is poorly researched and remains largely unsupported by experimental evidence, although clinical experience suggests a useful role for bisphosphonates, testosterone and perhaps fluorides. Symptom control and explanation remain the most important therapeutic interventions.