[Male osteoporosis].
BACKGROUND
Osteoporosis in men is an important public health problem with more than 1 million cases in Germany. Although osteoporotic fractures have a much higher mortality in men than in women, male patients are still underdiagnosed and undertreated.


OBJECTIVE
Epidemiology of male osteoporosis and current treatment situation, pathophysiological aspects at the hormonal level, risk factors, diagnostic work-up and therapeutic options.


METHODS
Overview of data concerning male osteoporosis, recommendations for diagnostic work-up and presentation of the study situation on pharmaceutical therapies.


RESULTS
As risk factors for osteoporosis are present in 50-70 % of male patients, a detailed patient history is necessary for assessment of the risk factors. Radiological imaging of the spine is primarily recommended to identify individuals with prevalent vertebral fractures, as approximately 10 % of males above the age of 50 years have suffered a vertebral fracture. Laboratory testing of relevant parameters helps to rule out other metabolic bone diseases. In Germany, specific medications available for the treatment of male osteoporosis comprise the active vitamin D analogue alfacalcidol, the oral bisphosphonates alendronate and risedronate, the intravenous biphosphonate zoledronic acid, the anti- receptor activator of NF-κB ligand (RANKL) antibody denosumab, which can be given as intravenous injection and strontium ranelate, a drug with a complex mode of action. Teriparatide, a recombinant form of the 34 N-terminal amino acid sequence of parathyroid hormone is the only anabolic agent approved for male osteoporosis.


CONCLUSIONS
Osteoporosis in men is increasingly being recognized as an important public health problem and affected patients need to be adequately diagnosed and treated. Nowadays, a broad spectrum of well-proven therapeutic options with different modes of action allow individual treatment strategies for male osteoporosis patients.
Medizinische Klinik II, Nephrologie und Nierentransplantation, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Klinikstr. 33, 35392, Gießen, Deutschland. parvis@farahmand.de.
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Farahmand
Medizinische Klinik, Abteilung für Innere Medizin, Universitätsspital Basel, Am Petersgraben 4, 4031, Basel, Schweiz.
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Spiegel
Westdeutsches Osteoporose Zentrum, Medizinische Klinik 4, Klinikum Leverkusen, Am Gesundheitspark, Leverkusen, Deutschland.
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Ringe
D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D015984:Causality; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005858:Germany / Q000453:epidemiology; D020249:Hormone Replacement Therapy / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D054526:Men's Health / Q000706:statistics & numerical data; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000453:epidemiology*; D058866:Osteoporotic Fractures / Q000453:epidemiology* / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome
D050071:Bone Density Conservation Agents
Diagnostics; Fracture; Men; Mortality; Osteoporosis; Risk factors; Therapy