Update on male osteoporosis
PURPOSE: Fragility fractures are increasingly recognized as an important cause of morbidity and mortality in men. This review focuses on the potential causes, means of diagnosis, and available treatment for male osteoporosis. EPIDEMIOLOGY: More than 2 million men in the United States have osteoporosis, and approximately 1 in 5 fractures occur in men. Moreover, it is estimated that there will be 800 000 hip fractures in men worldwide in 2025, reflecting a greater rate of increase in men (89%) than that in women (69%). REVIEW SUMMARY: Male osteoporosis is a multifactorial disorder with testosterone deficiency, excessive glucocorticoids, and excess alcohol intake the most commonly observed causes. Although the lifetime risk of fracture is lower in men than in women, men have higher mortality rates after hip and other types of osteoporotic fracture. Diagnostic assessment of osteoporosis in men generally should be more comprehensive than that in women, given that more than half of men will have an identifiable secondary disorder that contributes to their disease. Treatment with pharmacologic agents does have favorable effects on bone mineral density in men, though definitive evidence of antifracture benefit is lacking to date. TYPE OF AVAILABLE EVIDENCE: Systematic reviews, prospective cohort studies, randomized-controlled trials, meta-analyses. GRADE OF AVAILABLE EVIDENCE: Fair. CONCLUSION: Male osteoporosis is a common disorder associated with significant morbidity and mortality. An approach of lifestyle modification, appropriate nutrition (with calcium/vitamin D), and selective use of pharmacologic agents appears to confer skeletal benefit to men similar to that in women.
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