Management of Male Osteoporosis: an Update
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Purpose of review
Osteoporosis is a major health concern for men in our aging population. The incidence of osteoporotic fractures in men is expected to rise as life expectancy increases. When adjusted for age, one half of all hip fractures occur in men and of all osteoporotic fractures; hip fractures account for the highest morbidity and mortality. Several factors contribute to bone loss in men. Sex steroid deficiency plays an important role in male age-related bone loss. Careful evaluation for secondary causes of bone loss (including lifestyle factors, comorbidities, and risk medications) is warranted.
Osteoporosis guidelines recommend bone mineral density (BMD) testing in men over age 70, earlier in men with other risk factors. As in women, adequate calcium and vitamin D intake, regular weight-bearing exercise, smoking cessation, limiting excessive alcohol, and fall prevention strategies are recommended. Available clinical data support efficacy of bisphosphonates (alendronate, risedronate, zoledronic acid), denosumab, and anabolic therapy (teriparatide) in men with osteoporosis as well as in women. Abaloparatide, a parathyroid hormone-related peptide analog with demonstrated anti-fracture efficacy in women, awaits the conclusion of clinical trials in men. Romosozumab shows similar BMD and bone turnover marker effects in osteoporotic men compared to women; evaluation of safety concerns is ongoing.
Recent insights into osteoporosis pathophysiology and bone cell biology provide promising direction for effective therapeutic strategies for the management of male osteoporosis.
KeywordsMale osteoporosis Fracture Pathophysiology Testosterone Secondary osteoporosis Osteoporosis therapy
Compliance with Ethical Standards
Conflict of interest
Dr. Kendler reports grants and personal fees from Amgen, grants and personal fees from Eli Lilly, grants from Astrazenica, personal fees from Pfizer, outside the submitted work.
Mohammed Almohaya declares that there is no conflict of interest.
Ahmad Alobedollah declares that there is no conflict of interest.
Human and animal rights and informed consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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