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Fracture prevention in men

Nature Reviews Rheumatology volume 5, pages 497–504 (2009)Cite this article

Abstract

The lifetime risk of experiencing a fracture in 50-year-old men is lower (20%) than the risk in women (50%). Consequently, much less research has been carried out on osteoporosis and fracture risk in men. Differences in the risk and incidence of fractures between men and women are related to differences in bone-related and fall-related factors between the sexes. During the past decade, progress has been achieved in case finding and fracture prevention in men. Epidemiology studies have better specified the prevalence and incidence of fractures, and insight into the pathophysiology of osteoporosis and fractures in men has progressed considerably. Case finding for men and women at the highest risk of fracture is now possible using the FRAX® algorithm, which includes clinical risk factors, with and without bone mineral density, and allows calculation of an individual's 10-year fracture risk. Although strategies to prevent fractures are much less common in men than in women, several treatment options are now available for this purpose. Bisphosphonates, in particular, consistently demonstrate a positive effect on bone mineral density, and some data also indicate decreased rates of vertebral fractures. For men with severe osteoporosis, treatment with the anabolic agent teriparatide might be an effective option.

Key Points

  • At the age of 50 years, the lifetime risk of fractures in men is lower (20%) than in women (50%)

  • The risk of a subsequent vertebral fracture is highest within the first years of an initial fracture

  • Differences in fracture risk and incidence between men and women are related to differences in bone-related and fall-related factors

  • Identifying women and men at highest risk of fracture is now feasible with the introduction of the FRAX® algorithm, which enables calculation of a 10-year fracture risk

  • Prevention of vertebral fractures in men at high risk has been demonstrated for treatment with bisphosphonates and teriparatide

  • An increased awareness regarding fracture risk, its complications, and the possibilities of preventing first and subsequent fractures in men is required

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Figure 1: Pathophysiology and consequences of fractures.
Figure 2: Average annual fracture incidence rate per 10,000 population, by age group and sex, of a study group based in Leicestershire, UK.
Figure 3: Summary of growth-related and age-related changes in axial and appendicular skeletal mass, size and density.42

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Authors and Affiliations

  1. Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands

    Piet Geusens

  2. Institute of Bone and Joint Research, University of Sydney, NSW, Australia

    Philip Sambrook

  3. Department of Rheumatology, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands

    Willem Lems

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Correspondence to Piet Geusens.

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Competing interests

W. Lems has received speakers' honoraria from Eli Lilly, Merck Sharp & Dohme, Procter and Gamble, Roche, and Servier. P. Geusens and P. Sambrook declare no competing interests.

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Geusens, P., Sambrook, P. & Lems, W. Fracture prevention in men. Nat Rev Rheumatol 5, 497–504 (2009). https://doi.org/10.1038/nrrheum.2009.148

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