Osteoporosis is a silent disorder characterized by reduced bone strength predisposing to increased fracture risk. Although osteoporosis affects women more often than men, ~20% of the 44 million Americans who have osteoporosis or low BMD are men. Between 30 and 40% of fractures due to osteoporosis occur in men; the lifetime risk of fracture for men aged 50 or older is between 13 and 30%. Osteoporosis in men causes significant morbidity and mortality. The major mechanism underlying bone loss with ageing in men is sex hormone deficiency, both testosterone and oestradiol. Mens larger bones are likely a consequence of testosterones effect on periosteal apposition and this contributes to greater bone strength. There are other reasons why men have fewer fractures than women. Men fall less often than women; higher androgen levels have been associated with reduced fall risk. Finally, men have a shorter life expectancy. The European Society for Endocrinology worked with the Endocrine Society to develop guidelines for male osteoporosis1. They recommended testing higher risk men (aged ≥70 and men aged 5069 who have risk factors (e.g. low body weight, prior fracture as an adult, smoking, etc.)) using central dual-energy X-ray absorptiometry. Laboratory testing should be done to detect contributing causes. Adequate calcium and vitamin D and weight-bearing exercise should be encouraged; smoking and excessive alcohol should be avoided. Pharmacological treatment is recommended for men aged 50 or older who have had spine or hip fractures, those with T-scores of −2.5 or below, and men at high risk of fracture based on low bone mineral density and/or clinical risk factors. Treatment should be monitored with serial dual-energy X-ray absorptiometry testing.
Reference: 1. Watts NB, Adler RA, Bilezikian JP, Drake MT, Eastell R, Orwoll ES, Finkelstein JS; Endocrine Society. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012 97 (6) 18021822.