Osteoporosis in men.

Abstract

Osteoporosis is one of the most common metabolic bone diseases, and its prevalence will rise as our population grows older. Although osteoporosis is less common in men than in women its morbidity and mortality seem to be even greater. Furthermore the incidence of osteoporosis in men may well be underestimated, since men are far less likely than women to have a bone density scan. Epidemiological studies suggest that, in the USA, about 1.5 million men over 65 years of age have osteoporosis and another 8-13 million have osteopenia1. The calculated lifetime risk of fracture for men is 13.5% at the age of 50 years and 25.6% at the age of 601. The prevalence in men of fractures of the spine or hip is about one-third that in women2. There seems to be a lag period such that an exponential increase in fracture incidence begins 10 years later in men than in women3, coinciding with the phase of accelerated bone loss after the age of 704. Although women have a higher overall prevalence of fracture, the increase in fracture risk for each standard deviation decrease in bone mineral density (BMD) seems to be higher in men. Moreover, mortality associated with hip fracture is two to three times higher in men than in women5,6,7,8. Strict criteria for the diagnosis of osteoporosis in men are still lacking: the World Health Organization definition, based on a T score greater than -2.5, relates to Caucasian women. The underlying mechanisms, risk factors and natural history of osteoporosis in men are now attracting much research attention.