Endocrine Abstracts

Osteoporosis in men is recently recognized as a major underestimated public health problem. In 2050, the incidence of hip fracture in men is expected to increase by 310% worldwide. After the age of 50, one out of three osteoporotic fractures are seen in men. Men suffering any major fracture have a higher mortality rate than women osteoporotic fractures. Screening is usually recommended in many guidelines above the age of 65 or 70 years and those younger aged with risk for osteoporosis. However, its relevance requires validation through prospective studies.

Fifty percent of the causes leading osteoporotic fractures in men are potentially treatable. Treatment decisions should be based on clinical evaluation, fracture risk assessment, diagnostic workup, and Bone mineral density measurements. Current Guidelines suggest initiating treatment in men over 50 with a history of hip or spine fractures and those with a T-score of −2.5 or below and men at high risk for fracture based on low BMD and/or clinical risk factors.Although it’s less defined than women pharmacologic and nonpharmacologic management options exists for prevention and treatment of osteoporosis in men. Calcium consumption from dietary sources (with supplementation if necessary) along with appropriate vitamin D levels are recommended. Pharmacological agents approved for treatment of osteoporosis in men include the anti-resorptive drugs bisphosphonates (alendronate, residronate and zoledronic acid) and denosumab, the bone-forming agent teriparatide, and strontium ranelate. The evidence level for efficacy and safety of these drugs in men is still needs to be evaluated but recent data indicate that treatment effects of anti-osteoporotic drugs in men are very similar to what has been observed in the treatment of postmenopausal osteoporosis.

Growing body of evidence indicates of medical, economic and social impacts of male osteoporosis, currently only minority of men with high risk of fracture are detected and treated appropriately.