Osteoporosis in men: a review

Abstract

Osteoporosis and consequent fracture are not limited to postmenopausal women. There is increasing attention being paid to osteoporosis in older men. Men suffer osteoporotic fractures about 10 years later in life than women, but life expectancy is increasing faster in men than women. Thus, men are living long enough to fracture, and when they do the consequences are greater than in women, with men having about twice the 1-year fatality rate after hip fracture, compared to women. Men at high risk for fracture include those men who have already had a fragility fracture, men on oral glucocorticoids or those men being treated for prostate cancer with androgen deprivation therapy. Beyond these high risk men, there are many other risk factors and secondary causes of osteoporosis in men. Evaluation includes careful history and physical examination to reveal potential secondary causes, including many medications, a short list of laboratory tests, and bone mineral density testing by dual energy X-ray absorptiometry (DXA) of spine and hip. Recently, international organizations have advocated a single normative database for interpreting DXA testing in men and women. The consequences of this change need to be determined. There are several choices of therapy for osteoporosis in men, with most fracture reduction estimation based on studies in women.

Osteoporosis: Older men are also at risk

The serious consequences of osteoporosis in men deserve greater attention from both patients and clinicians. Robert Adler from the McGuire Veterans Affairs Medical Center in Richmond, Virginia, USA, reviews the risk factors in men for osteoporotic bone fractures, a problem long thought to be mainly limited to postmenopausal women. The author discusses the ways in which the outcomes of the disease differ between the sexes. Men, for example, experience hip fractures on average a decade later in life than women but the one-year fatality rates from such breaks are about twice as high. Adler calls for more evaluations in older men by history, physical examination, and laboratory testing in addition to bone mineral density. This would improve the diagnosis and treatment of osteoporosis in this underserved but at-risk population.

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