Hormones and osteoporosis in the aging male

Abstract

Bone loss accelerates with aging in men and women. Loss of androgens in later life is associated with increased bone resorption.The decreases in levels of testosterone, estrogen and vitamin D concomitant with increased parathyroid hormone levels are important mechanisms in the pathogenesis of bone fragility in elderly men. Many men with fractures have underlying causes of bone loss, e.g. alcohol abuse, glucocorticoid medication, intestinal bowel disease.In women, similar changes have been implied in the pathogenesis of senile osteoporosis. The role of estrogens in osteoporotic men is suggested by the association of low bone density and decreased estradiol serum levels in male hypogonadism. The estradiol serum levels of healthy men seem to have clinical impact for the pathogenesis of male osteoporosis, as already investigated for postmenopausal women, albeit less well recognized.At present, no antifracture efficacy studies are available in male osteoporosis. The use of vitamin D in the treatment of male osteoporosis and prevention of hip fractures is justified since vitamin D deficiency is frequently found in elderly men. Testosterone treatment studies have shown a decline of biochemical parameters and an increase in bone formation. More data are needed for the potential therapeutic use of androgens in elderly men with osteoporosis; however, bisphosphonates appear to be beneficial for these patients.