Background for studies on the treatment of male osteoporosis: state of the art
J M Kaufman, O Johnell, E Abadie, S Adami, M Audran, B Avouac, W Ben Sedrine, G Calvo, J P Devogelaer, V Fuchs, G Kreutz, P Nilsson, H Pols, J Ringe, L Van Haelst, J Y Reginster*
Correspondence to: Dr J Y Reginster, Unité d'exploratioin du métabolisme osseux, Policlinique Universitaire L Brull, Quai Godefroid Kurth 45, 4020 Liège, Belgium jyreginster{at}ulg.ac.be
Accepted for publication 27 June 2000
Male osteoporosis represents an important, although long
underestimated, public health problem. Both in men and in women aging is accompanied by continuous bone loss and by an exponential increase in the incidence of osteoporotic fracture, with a female to male incidence ratio of about 2 to 3 to 1 in the elderly for hip and vertebral fractures. Morbidity after osteoporotic fractures appears to
be more serious and mortality more common in men than in women. To
date, no single treatment has been proved to be effective and safe in
published prospective studies.
The present report, based on a systematic search of the
literature on male osteoporosis, summarises the state of the art on the
clinical consequences of male osteoporosis and its risk factors, in
relation to the present state of knowledge about female osteoporosis.
This constitutes the background for the design of rational clinical
development strategies for therapeutic interventions in male
osteoporosis. From this review of the literature it is apparent that
notwithstanding the existing sex differences in pathophysiology of
osteoporosis and the difference in age-specific incidence of
osteoporotic fractures, there are also important similarities between
osteoporosis in women and men. The higher incidence of fracture in
women than in men results from quantitative differences in risk factors
rather than from different risk factors. Even though there are sex
differences in bone geometry, incidence of fracture seems to be similar
in men and women for a same absolute areal bone mineral density.
However, the lack of data on the changes in fracture rates in men
resulting from pharmacological intervention, leading to changes in bone
mineral density or bone turnover, remains the main limitation for
extrapolation of established treatment outcomes from women to men.
* Addresses given in the appendix.
© 2000 by Annals of the Rheumatic Diseases
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