Management of Male Osteoporosis

  • Piet GeusensEmail author
  • Joop van den Bergh


After middle age, osteoporosis-related fractures are more common in women than in men. As a result, fracture prevention has been most extensively studied in postmenopausal women. However, between 30% and 40% of fractures due to osteoporosis occur in men, and the lifetime risk of fracture for men aged 50 or older is between 13% and 30%. During aging, fracture risk rises exponentially in both sexes, but the increase occurs about a decade later in men than in women. The mortality rate of patients with hip fractures older than 70 years is two to three times higher in men than in women. In contrast to the risk of a first fracture after the age of 50 years, which is higher in women than in men, the risk of a subsequent fracture after a first fracture is the same for both sexes. Therefore, men older than 50 years deserve attention for fracture risk evaluation and fracture prevention in high-risk patients.


Male osteoporosis Fracture prevention DXA Clinical case finding FRAX Risk evaluation 


  1. 1.
    Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17:1726–33.CrossRefGoogle Scholar
  2. 2.
    Cooper C, Melton LJ 3rd. Epidemiology of osteoporosis. Trends Endocrinol Metab. 1992;3:224–9.CrossRefGoogle Scholar
  3. 3.
    Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301:513–21.CrossRefGoogle Scholar
  4. 4.
    van Helden S, van Geel AC, Geusens PP, Kessels A, Nieuwenhuijzen Kruseman AC, Brink PR. Bone and fall-related fracture risks in women and men with a recent clinical fracture. J Bone Joint Surg Am. 2008;90:241–8.CrossRefGoogle Scholar
  5. 5.
    van Geel TA, van Helden S, Geusens PP, Winkens B, Dinant GJ. Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis. 2009;68:99–102.CrossRefGoogle Scholar
  6. 6.
    van den Bergh JP, van Geel TA, Geusens PP. Osteoporosis, frailty and fracture: implications for case finding and therapy. Nat Rev Rheumatol. 2012;8:163–72.CrossRefGoogle Scholar
  7. 7.
    Leslie WD, Schousboe JT. A review of osteoporosis diagnosis and treatment options in new and recently updated guidelines on case finding around the world. Curr Osteoporos Rep. 2011;9:129–40.CrossRefGoogle Scholar
  8. 8.
    Geusens PP, Bone v d BJP. New guidelines for multistep fracture prevention in men. Nat Rev Rheumatol. 2012;8:568–70.CrossRefGoogle Scholar
  9. 9.
    Watts NB, Adler RA, Bilezikian JP, et al. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97:1802–22.CrossRefGoogle Scholar
  10. 10.
    Kaufman JM, Reginster JY, Boonen S, et al. Treatment of osteoporosis in men. Bone. 2013;53:134–44.CrossRefGoogle Scholar
  11. 11.
    Akesson K, Marsh D, Mitchell PJ, et al. Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle. Osteoporos Int. 2013;24:2135–52.CrossRefGoogle Scholar
  12. 12.
    McLellan AR, Gallacher SJ, Fraser M, McQuillian C. The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int. 2003;14:1028–34.CrossRefGoogle Scholar
  13. 13.
    Lewis CE, Ewing SK, Taylor BC, et al. Predictors of non-spine fracture in elderly men: the MrOS study. J Bone Miner Res. 2007;22:211–9.CrossRefGoogle Scholar
  14. 14.
    Chapurlat RD, Duboeuf F, Marion-Audibert HO, Kalpakcioglu B, Mitlak BH, Delmas PD. Effectiveness of instant vertebral assessment to detect prevalent vertebral fracture. Osteoporos Int. 2006;17:1189–95.CrossRefGoogle Scholar
  15. 15.
    Bours SP, van den Bergh JP, van Geel TA, Geusens PP. Secondary osteoporosis and metabolic bone disease in patients 50 years and older with osteoporosis or with a recent clinical fracture: a clinical perspective. Curr Opin Rheumatol. 2014;26:430–9.CrossRefGoogle Scholar
  16. 16.
    Orwoll E, Ettinger M, Weiss S, et al. Alendronate for the treatment of osteoporosis in men. N Engl J Med. 2000;343:604–10.CrossRefGoogle Scholar
  17. 17.
    Gonnelli S, Cepollaro C, Montagnani A, et al. Alendronate treatment in men with primary osteoporosis: a three-year longitudinal study. Calcif Tissue Int. 2003;73:133–9.CrossRefGoogle Scholar
  18. 18.
    Boonen S, Orwoll ES, Wenderoth D, Stoner KJ, Eusebio R, Delmas PD. Once-weekly risedronate in men with osteoporosis: results of a 2-year, placebo-controlled, double-blind, multicenter study. J Bone Miner Res. 2009;24:719–25.CrossRefGoogle Scholar
  19. 19.
    Orwoll ES, Binkley NC, Lewiecki EM, Gruntmanis U, Fries MA, Dasic G. Efficacy and safety of monthly ibandronate in men with low bone density. Bone. 2010;46:970–6.CrossRefGoogle Scholar
  20. 20.
    Orwoll ES, Miller PD, Adachi JD, et al. Efficacy and safety of a once-yearly i.v. Infusion of zoledronic acid 5 mg versus a once-weekly 70-mg oral alendronate in the treatment of male osteoporosis: a randomized, multicenter, double-blind, active-controlled study. J Bone Miner Res. 2010;25:2239–50.CrossRefGoogle Scholar
  21. 21.
    Lyles KW, Colon-Emeric CS, Magaziner JS, et al. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med. 2007;357:1799–809.CrossRefGoogle Scholar
  22. 22.
    Boonen S, Reginster JY, Kaufman JM, et al. Fracture risk and zoledronic acid therapy in men with osteoporosis. N Engl J Med. 2012;367:1714–23.CrossRefGoogle Scholar
  23. 23.
    Kaufman JM, Audran M, Bianchi G, et al. Efficacy and safety of strontium ranelate in the treatment of osteoporosis in men. J Clin Endocrinol Metab. 2013;98:592–601.CrossRefGoogle Scholar
  24. 24.
    Orwoll E, Teglbjaerg CS, Langdahl BL, et al. A randomized, placebo-controlled study of the effects of denosumab for the treatment of men with low bone mineral density. J Clin Endocrinol Metab. 2012;97:3161–9.CrossRefGoogle Scholar
  25. 25.
    Langdahl BL, Teglbjaerg CS, Ho PR, et al. A 24-month study evaluating the efficacy and safety of denosumab for the treatment of men with low bone mineral density: results from the ADAMO trial. J Clin Endocrinol Metab. 2015;100:1335–42.CrossRefGoogle Scholar
  26. 26.
    Chavassieux P, Meunier PJ, Roux JP, Portero-Muzy N, Pierre M, Chapurlat R. Bone histomorphometry of transiliac paired bone biopsies after 6 or 12 months of treatment with oral strontium ranelate in 387 osteoporotic women: randomized comparison to alendronate. J Bone Miner Res. 2014;29:618–28.CrossRefGoogle Scholar
  27. 27.
    Smith MR, Egerdie B, Hernandez Toriz N, et al. Denosumab in men receiving androgen-deprivation therapy for prostate cancer. N Engl J Med. 2009;361:745–55.CrossRefGoogle Scholar
  28. 28.
    Orwoll ES, Scheele WH, Paul S, et al. The effect of teriparatide [human parathyroid hormone (1-34)] therapy on bone density in men with osteoporosis. J Bone Miner Res. 2003;18:9–17.CrossRefGoogle Scholar
  29. 29.
    Kurland ES, Cosman F, McMahon DJ, Rosen CJ, Lindsay R, Bilezikian JP. Parathyroid hormone as a therapy for idiopathic osteoporosis in men: effects on bone mineral density and bone markers. J Clin Endocrinol Metab. 2000;85:3069–76.PubMedGoogle Scholar
  30. 30.
    Kaufman JM, Orwoll E, Goemaere S, et al. Teriparatide effects on vertebral fractures and bone mineral density in men with osteoporosis: treatment and discontinuation of therapy. Osteoporos Int. 2005;16:510–6.CrossRefGoogle Scholar
  31. 31.
    Abrahamsen B, Osmond C, Cooper C. Life expectancy in patients treated for osteoporosis: observational cohort study using national Danish prescription data. J Bone Miner Res. 2015;30:1553–9.CrossRefGoogle Scholar
  32. 32.
    McClung M, Harris ST, Miller PD, et al. Bisphosphonate therapy for osteoporosis: benefits, risks, and drug holiday. Am J Med. 2013;126:13–20.CrossRefGoogle Scholar
  33. 33.
    Schiebinger L, Klinge I, Sánchez de Madariaga I, Paik HY, Schraudner M, Stefanick M (eds). Osteoporosis research in men: rethinking standards and reference models. Gendered Innovations in Science, Health & Medicine, Engineering and Environment (2011–2015). Accessed 14 Jan 2016.

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineMaastricht University Medical CenterMaastrichtThe Netherlands

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