Osteoporosis in Males

Excerpt

Osteoporosis is a silent disorder characterized by reduced bone density and structural deterioration of bone microarchitecture leading to fragility and increased risk of fractures. It has been mainly considered a post-menopausal condition, due to the known effects of reduced estrogen on the decrease in bone mass in females. However, the acknowledgment of the osteoporosis burden in the male population has grown in the past decades, associated with the increase of fragility fractures in the population, likely due to longer life span observed worldwide, a more sedentary lifestyle, and increased prevalence of risk factors.

The World Health Organization (WHO) and the International Society for Clinical Densitometry (ISCD) have defined diagnostic criteria for low bone mass (osteopenia) and osteoporosis based on bone mineral density (BMD) measurements in a dual-energy x-ray absorptiometry (DEXA) scan compared with a reference population. For males, it is recommended to use the same thresholds as females although the densitometric definition is not as well standardized as in postmenopausal women.

Although the prevalence of osteoporosis is higher in females, males present with higher mortality risk following a fracture. That is true for both vertebral and non-vertebral fractures. Despite high mortality and morbidity in males, unfortunately, most randomized controlled trials for osteoporosis treatment only include postmenopausal females, resulting in a challenge in managing osteoporosis in males.