Endocrine Abstracts

Background: Male osteoporosis is undermanaged. The characteristics of men referring to health care system for bone evaluation remain partially unknown.

Aim: To characterize from real-life data male patients seeking the first bone health evaluation at a tertiary academic medical center, referral for both andrological and bone diseases, over a 13-year observation period.

Methods: Retrospective, cross-sectional study, including adult men referring to our Center from 2007 to 2020 for bone health evaluation. Reasons for referral, risk factors for osteoporosis and comorbidities were investigated. Osteoporosis and osteopenia were defined considering DXA outcomes, according to WHO and ISCD criteria, and history of fragility fractures.

Results: A total of 455 men (age 62.5±15.1years) were included: 42 aged 18–40 years, 57 aged 40–50, 79 aged 50–60, 109 aged 60–70, 122 aged 70–80, and 46 aged >80. Overall, 125 patients (27.4%) were already followed by endocrinologists due to endocrinological/andrological diseases known to increase fracture risk (94 men) or not (31 men); general practitioners and other specialists asked for bone evaluation for 226 (49.6%) and 101 (22.1%) men. DXA has been already performed for 354 patients. Prevalence of osteoporosis, osteopenia, and low bone mineral density for age were 25.9%, 26.4% and 13.2%, respectively. Fractures were the most frequent reasons for referral. At least one fragility fracture has already occurred in 213 patients (46.8%), with higher prevalence in non-endocrinological than endocrinological patients (56% vs 24%, P<0.001). Sites of fracture were lumbar spine (128 patients,60%), femoral neck alone or in combination with other sites (50 patients, 23.4%). A total of 344 patients (76%) was already known to be affected by one or more comorbidities associated to bone loss, with higher prevalence in fractured patients compared to non-fractured (P=0.036). Among fractured patients, 49 of them (23%) have never been treated with any anti-osteoporotic therapy, including calcium and vitamin D supplementation.

Conclusions: Male osteoporosis presents with a high rate of fragility fractures (about 50%) among men referring to a tertiary academic medical center. The high prevalence of comorbidities associated to bone loss suggests that secondary forms of osteoporosis prevails in men, and they should be carefully investigated to identify patients at increased fracture risk. Most of fractured patients have not been previously evaluated by a clinician with expertise in bone diseases or properly treated, suggesting that awareness for male osteoporosis needs to be reinforced in primary healthcare setting in order to prevent fractures. This disease remains still overlooked and unaddressed.