Osteoporosis in men: epidemiology, diagnosis, prevention, and treatment.
BACKGROUND
Osteoporosis and fragility fractures in men account for substantial health care expenditures and decreased quality of life.


OBJECTIVE
This article reviews the most current information about the epidemiology, diagnosis, prevention, and treatment of osteoporosis in men.


METHODS
Relevant literature was identified through a search of MEDLINE (1966-June 2003) limited to English-language studies in men. The search terms included fractures, bone density, or osteoporosis plus either epidemiology, diagnosis, prevention, control, or therapy. Additional search terms included specific subtopics (eg, bisphosphonates, calcium, exercise, parathyroid hormone). The authors contributed additional relevant publications.


RESULTS
Morbidity after fragility fracture is at least as high in men as in women, and the rate of fracture-related mortality 1 year hip fracture is approximately double in men compared with women. The bioavailable fraction of testosterone slowly declines into the ninth decade in men. There is evidence that the effect of estrogen on bone is greater than that of testosterone in men. Diagnosing osteoporosis in men is complicated by a lack of consensus on how it should be defined. Significant risk factors for osteoporosis or fracture include low bone mineral density, previous fragility fracture, maternal history of fracture, marked hypogonadism, smoking, heavy alcohol intake or alcoholism, low calcium intake, low body mass or body mass index, low physical activity, use of bone-resorbing medication such as glucocorticoids, and the presence of such conditions as hyperthyroidism, hyperparathyroidism, and hypercalciuria. Prevention is paramount and should begin in childhood. During adulthood, calcium (1000-1500 mg/d), vitamin D (400-800 IU/d), and adequate physical activity play crucial preventive roles. When treatment is indicated, the bisphosphonates are the first choice, whereas there is less support for the use of calcitonin or androgen therapy. Parathyroid hormone (1-34) is a promising anabolic therapy. There is also strong evidence for the use of bisphosphonates for the treatment of glucocorticoid-induced osteoporosis.
Department of Medicine, University of Saskatchewan, Saskatoon Osteoporosis Centre, Saskatoon, Saskatchewan, Canada. olszynski@webster.sk.ca
Wojciech P
WP
Olszynski
K
K
Shawn Davison
Jonathan D
JD
Adachi
Jacques P
JP
Brown
Steven R
SR
Cummings
David A
DA
Hanley
Steven P
SP
Harris
Anthony B
AB
Hodsman
David
D
Kendler
Michael R
MR
McClung
Paul D
PD
Miller
Chui Kin
CK
Yuen
D000728:Androgens / Q000627:therapeutic use; D015519:Bone Density; D002116:Calcitonin / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D005459:Fluorides / Q000627:therapeutic use; D006801:Humans; D008019:Life Style; D008297:Male; D010024:Osteoporosis / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D010281:Parathyroid Hormone / Q000627:therapeutic use; D012307:Risk Factors; D014807:Vitamin D / Q000627:therapeutic use
D000728:Androgens; D004164:Diphosphonates; D010281:Parathyroid Hormone; D014807:Vitamin D; D002116:Calcitonin; D005459:Fluorides; D002118:Calcium