Osteoporosis in men

Abstract

Osteoporosis in men contributes to significant morbidity and mortality, yet is underrecognised. Hip fractures in men are associated with greater mortality (up to 37.5% in the first year) compared with women. Timely diagnosis and treatment of osteoporosis in men are therefore critical. Secondary causes for osteoporosis are common and need to be excluded. Absolute fracture risk assessment guides selection of men for anti-osteoporotic therapy. Most studies of oral or intravenous (i.v.) bisphosphonate therapy in hypogonadal and eugonadal men with osteoporosis have reported effects on bone mineral density (BMD) and biochemical bone turnover markers, rather than fragility fractures. Intravenous zoledronic acid given to elderly men and women after hip fracture, reduced clinical, clinical vertebral and nonvertebral fractures, and mortality compared with placebo infusions. Recent studies in men with osteoporosis have reported reductions in vertebral fractures with oral or i.v. bisphosphonates. All studies have been underpowered to detect reductions of nonvertebral and hip fractures. Teriparatide treatment also reduces vertebral fractures. Denosumab increases BMD and reduces bone turnover markers, while strontium ranelate increases BMD in men with osteoporosis. As evidence-based anti-osteoporosis treatment is available, family physicians and patients should recognize that osteoporosis can affect men, so that early diagnosis and treatment can be initiated.