Current Osteoporosis Reports

, Volume 12, Issue 4, pp 403–409 | Cite as

Osteoporosis Diagnosis in Men: The T-Score Controversy Revisited

  • Neil BinkleyEmail author
  • Robert Adler
  • John P. Bilezikian
Therapeutics and Medical Management (E Shane and RA Adler, Section Editors)


Osteoporosis becomes common with aging in both sexes, but is often ignored in men. The 2013 International Society for Clinical Densitometry consensus conference endorsed a Caucasian female referent database for T-score calculation in men. This recommendation has generated controversy and concern. Accumulating data indicate that at the same DXA-measured body mineral density (BMD) (g/cm2), men and women are at approximately the same fracture risk. With this point in mind, using the same database to derive the T-score in men and women is reasonable. As a result, a greater proportion of men who sustain a fragility fracture will have T-scores that are higher than they would if a male database were used; in fact, many men will fracture at T-scores that are “normal.” This highlights the importance of diagnosing osteoporosis not just by T-score, but also by the presence of fragility fracture and/or by estimations of fracture risk as generated by tools such as the FRAX calculator. The practical consequences of this change in densitometric definition of osteoporosis in men should be monitored, including the proportion of men at risk identified and treated as well as defining the response to treatment in those assessed by this more comprehensive approach.


Osteoporosis Men T-score Fracture Dual energy X-ray absorptiometry 


Compliance with Ethics Guidelines

Conflict of Interest

N. Binkley has received consultancy fees or funding from Merck Sharp & Dohme, Lilly, and Amgen.

R. Adler and J. P. Bilezikian declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

All studies by the authors involving animal and/or human subjects were performed after approval by the appropriate institutional review boards. When required, written informed consent was obtained from all participants.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Neil Binkley
    • 1
    Email author
  • Robert Adler
    • 2
  • John P. Bilezikian
    • 3
  1. 1.University of Wisconsin Osteoporosis Clinical Research ProgramMadisonUSA
  2. 2.Endocrinology SectionMcGuire Veterans Affairs Medical CenterRichmondUSA
  3. 3.Department of Medicine, Division of EndocrinologyCollege of Physicians and SurgeonsNew YorkUSA

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