Male osteoporosis

• Published in: Archives of Endocrinology and Metabolism Vol. 66; no. 5; pp. 739 - 747
• Main Authors: Bandeira, Leonardo, Silva, Barbara C., Bilezikian, John P.
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Endocrinologia e Metabologia 11.11.2022; Brazilian Society of Endocrinology and Metabolism
• Subjects: Absorptiometry, Photon; Bone Density; Female; Humans; hypogonadism; Hypogonadism - complications; Male; Middle Aged; Osteoporosis; Osteoporosis - complications; Osteoporosis, Postmenopausal; Osteoporotic Fractures - diagnosis; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - etiology; Review; Risk Assessment; Risk Factors; testosterone; Osteoporosis; hypogonadism; testosterone; male
• ISSN: 2359-3997; 2359-4292
• DOI: 10.20945/2359-3997000000563

Osteoporosis, a disease classically attributed to postmenopausal women, is underappreciated, underdiagnosed, and undertreated in men. However, it is not uncommon for osteoporotic fractures to occur in men. About 40% of fractures occur in men with an incidence that has increased over the years. After a first fracture, the risk of a subsequent episode, as well as the risk of death, is higher in the male than in the female population. Despite these facts, only 10% of men with osteoporosis receive adequate treatment. Up to half of the cases of male osteoporosis have a secondary cause, the most common being hypogonadism, excessive alcohol consumption, and chronic use of glucocorticoids. The International Society for Clinical Densitometry (ISCD) recommends using the female database for the diagnosis of osteoporosis by DXA (T-score ≤ -2.5 in men over 50 years old). In addition, osteoporosis can also be diagnosed independently of the BMD if a fragility fracture is present, or if there is a high risk of fractures by FRAX. Treatment is similar to postmenopausal osteoporosis, because the data regarding changes in bone density track closely to those in women. Data concerning fracture risk reduction are not as certain because the clinical trials have included fewer subjects for shorter period of time. In men with symptomatic hypogonadism, testosterone replacement, if indicated, can improve BMD.