Osteoporosis in men

Summary

Bone is lost with advancing age in men as in women, leading to an increased incidence of osteoporotic fractures of the fore-arm, vertebral body and femoral neck. By the ninth decade of life, 4% of men will have sustained a fore-arm fracture, 7% a vertebral fracture and 5% a femoral neck fracture. The absolute number of osteoporotic fractures is rising in men, because of the ageing population and an increase in the age-specific incidence of fractures. Even if the age-specific incidence of fractures stabilizes, demographic trends suggest that a further increase in the number of men with osteoporotic fractures is inevitable.

Peak bone mass in men is influenced by race, heredity, hormonal factors, physical activity and calcium intake during childhood and adolescence. Bone loss in men starts at about the age of 35 years and is regulated by genetic, endocrine, mechanical and nutritional factors. Secondary causes of osteoporosis may be detected in about 55% of men with vertebral crush fractures. The major causes are steroid therapy, hypogonadism, skeletal metastases, multiple myeloma, gastric surgery and anticonvulsant treatment.

Hypogonadism is found in up to 20% of men with vertebral crush fractures, although the clinical features of testosterone deficiency may not always be present. Hypogonadal osteoporosis is associated with increased bone resorption and decreased mineralization, which is reversed by treatment with testosterone, leading to an increase in bone density.

There is little published information on the treatment of primary osteoporosis in men. Although calcitonin, bisphosphonates and testosterone may be effective in the management of osteoporosis in men, confirmation is required in formal clinical trials.