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  • Review Article
  • Published:

Osteoporosis in men

Nature Reviews Endocrinology volume 9, pages 637–645 (2013)Cite this article

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Abstract

Osteoporotic fractures in older men (>50 years of age) are common and associated with considerable mortality and morbidity, but osteoporosis in men is under-recognized and undertreated. Secondary osteoporosis is also common in men, and causes include androgen deprivation therapy for prostate cancer, glucocorticoid treatment and alcohol excess. Clinical trials have demonstrated the efficacy of pharmacological osteoporosis treatments in men in terms of increasing BMD and decreasing levels of bone turnover markers; however, few trials have included fracture reduction end points. This Review will consider the pathophysiology of osteoporosis in men and the evidence for testing and treatment. The aims of the Review are to inform clinical practice, to discuss the current evidence base and to highlight the 2012 Endocrine Society clinical practice guidelines on osteoporosis in men.

Key Points

  • Fractures in men contribute considerably to the global morbidity and mortality of osteoporosis

  • Osteoporosis in men is currently under-recognized and undertreated

  • Current controversies include whether the male or female BMD reference range should be used for diagnosis of osteoporosis in men and the value of population screening for osteoporosis in men

  • Most osteoporosis treatments are licensed for use in men on the basis of BMD data rather than fracture data

  • The 2012 Endocrine Society guidelines on osteoporosis in men make recommendations on BMD testing and treatments, including advice on the use of testosterone in hypogonadal men at risk of fracture

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Figure 1: Fracture incidence rises with increasing age in men and women.
Figure 2: Bone changes with ageing.

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Authors and Affiliations

  1. Academic Unit of Bone Metabolism, Sorby Wing, Northern General Hospital, Herries Road, S5 7AU, Sheffield, UK

    Jennifer S. Walsh & Richard Eastell

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  1. Jennifer S. Walsh
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  2. Richard Eastell
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Both authors contributed equally to all aspects of this manuscript.

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Correspondence to Jennifer S. Walsh.

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Competing interests

Dr Walsh has received speaker fees from Eli Lilly. R. Eastell declares that he receives or has recently received grant support from the following companies: Amgen, AstraZeneca, Crescent Diagnostics, Eli Lilly, Osteologix, Immunodiagnostic Systems, Nestle Foundation, Nittoboseki, Procter & Gamble, Sanofi-Aventis and Unilever. He has recently received speaker's honoraria and/or travel expenses from the following companies: Amgen, Eli Lilly, Fonterra Brands, GlaxoSmithKline, Medtronics, Novartis, Ono Pharmaceuticals, Procter & Gamble, Roche, Takeda and Unilever. In 2010, he was a consultant for Amgen, AstraZeneca, Chronos, Eli Lilly, Fonterra Brands, GlaxoSmithKline, Immunodiagnostic Systems, Inverness Medical, Johnson & Johnson, Medtronics, Nastech, Nestle, Novartis, Ono Pharmaceuticals, Osteologix, Pfizer, Roche Diagnostics, Sanofi-Aventis, Tethys, Unilever and Unipath. In 2010 he was on the Advisory Board of Procter & Gamble.

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Walsh, J., Eastell, R. Osteoporosis in men. Nat Rev Endocrinol 9, 637–645 (2013). https://doi.org/10.1038/nrendo.2013.171

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