Abstract
Male osteoporosis is a still largely underdiagnosed pathological condition. As a consequence, bone fragility in men remains undertreated mainly due to the low screening frequency and to controversies in the bone mineral density (BMD) testing standards. Up to the 40% of overall osteoporotic fractures affect men, in spite of the fact that women have a significant higher prevalence of osteoporosis. In addition, in males, hip fractures are associated with increased morbidity and mortality as compared to women. Importantly, male fractures occur about 10 years later in life than women, and, therefore, due to the advanced age, men may have more comorbidities and, consequently, their mortality is about twice the rate in women. Gender differences, which begin during puberty, lead to wider bones in males as compared with females. In men, follicle-stimulating hormones, testosterone, estrogens, and sex hormone-binding levels, together with genetic factors, interact in determining the peak of bone mass, BMD maintenance, and lifetime decrease. As compared with women, men are more frequently affected by secondary osteoporosis. Therefore, in all osteoporotic men, a complete clinical history should be collected and a careful physical examination should be done, in order to find clues of a possible underlying diseases and, ultimately, to guide laboratory testing. Currently, the pharmacological therapy of male osteoporosis includes aminobisphosphonates, denosumab, and teriparatide. Hypogonadal patients may be treated with testosterone replacement therapy. Given that the fractures related to mortality are higher in men than in women, treating male subjects with osteoporosis is of the utmost importance in clinical practice, as it may impact on mortality even more than in women.
Highlights
The public health burden due to osteoporosis and fragility fractures is progressively rising as the ageing population increases in many countries
Odanacatib was the first Cathepsin K (CK)-inhibitor used in clinical studies on osteoporosis, and it showed a good efficacy in suppressing bone resorption markers, in increasing bone mineral density (BMD), and in reducing fracture risk, together with a lower inhibition of bone formation
While the BMD determination by DXA is recommended for all men above 70 years of age, in younger individuals, the screening for osteoporosis is recommended in the presence of incident fragility, fractures, and/or of one major risk factor among delayed puberty, hypogonadism, hyperparathyroidism, hyperthyroidism, chronic obstructive pulmonary disease, use of glucocorticoids or androgen deprivation therapy (ADT), alcohol abuse and smoking habit, or other causes of secondary osteoporosis (Table 1)
Summary
The public health burden due to osteoporosis and fragility fractures is progressively rising as the ageing population increases in many countries. As osteoporosis is commonly considered to be a female disease, it is clear that, in men, whose lifetime risk of fracture at the age of 50 is around the 13% [1], it is even more underestimated [3]. A small proportion of men with fractures are correctly screened for osteoporosis and treated with the appropriate drugs [3]. The present paper is not intended to be a systematical review of the literature on male osteoporosis. As far as an enormous number of papers has been produced on this matter, we aimed to create an easy and practical narrative review for the colleagues looking for a summary on male osteoporosis, for those approaching it for the first time
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