[Osteoporosis in the man: diagnosis and therapy]

The prevalence of osteoporosis in men has been underestimated in the past. Vertebral fractures were found in about 10% in men of age 50 and over 20 to 30% of all hip fractures in advanced age occur in men. Lower life expectancy of men but also differences in bone geometry and remodeling contribute to the lower rate of fractures in comparison to the female gender. In men with suspected osteoporosis a thorough history, physical and clinical examination is mandatory to exclude other localized or generalized osteopathies and to differentiate in primary and secondary osteoporosis. Only some small studies have been published so far on treatment of osteoporosis in men, i.e. therapeutic decisions are mainly based on existing results in postmenopausal osteoporosis. The basis of treatment is calcium and vitamin D supplementation and individually adapted recommendations on life style and risk factor avoidance. In established osteoporosis in adequate analgesic therapy is very important. In cases with secondary osteoporosis, if possible, etiological therapy should be started. Antiresorptive therapy (e.g. calcitonin, bisphosphonates) or osteoanabolic therapy (e.g. fluoride) can later be added, while in idiopathic osteoporosis this is the first option. According to the existing experiences there is in general a good chance to ameliorate the condition in men. There is however an urgent need for further data on therapy of osteoporosis in men.