Insights and implications of sexual dimorphism in osteoporosis

Abstract

Osteoporosis, a metabolic bone disease characterized by low bone mineral density and deterioration of bone microarchitecture, has led to a high risk of fatal osteoporotic fractures worldwide. Accumulating evidence has revealed that sexual dimorphism is a notable feature of osteoporosis, with sex-specific differences in epidemiology and pathogenesis. Specifically, females are more susceptible than males to osteoporosis, while males are more prone to disability or death from the disease. To date, sex chromosome abnormalities and steroid hormones have been proven to contribute greatly to sexual dimorphism in osteoporosis by regulating the functions of bone cells. Understanding the sex-specific differences in osteoporosis and its related complications is essential for improving treatment strategies tailored to women and men. This literature review focuses on the mechanisms underlying sexual dimorphism in osteoporosis, mainly in a population of aging patients, chronic glucocorticoid administration, and diabetes. Moreover, we highlight the implications of sexual dimorphism for developing therapeutics and preventive strategies and screening approaches tailored to women and men. Additionally, the challenges in translating bench research to bedside treatments and future directions to overcome these obstacles will be discussed.

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Funding

Ningbo medical and health brand discipline (No.PPXK2018-02), Ningbo Clinical Research Center for Otolaryngology Head and Neck Disease (No.2022L005).

the National Natural Science Foundation of China (82170844), the Sichuan Science and Technology Program (2022YFH0045),the 111 Project (B18035)

the National Natural Science Foundation of China (82270613), the Sichuan Science and Technology Program (2022YFH0102)

1·3·5 project for disciplines of excellence, West China Hospital, Sichuan University (ZYGD22007, ZYJC21004)