Practice Cases
Male Osteoporosis: Key Points
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- Age-related changes in bone mineral density (BMD) are similar in men and women.
- Onset of symptomatic osteoporosis in men is delayed by 5 years versus women. This is due to their greater peak BMD.
- The overall incidence of symptomatic hip fracture in persons age 60 and over is 29 percent for men and 56 percent for women.
- The fracture rate for the same absolute real BMD level is the same in men and women.
- Risk factors for hip fracture are similar in men and women.
- Mortality associated with hip and other fractures is higher in men than in women.
- Routine BMD screening of men is not recommended by the USPSTF but is by the National Osteoporosis Foundation for men 70 and older. BMD testing should be considered in men with evidence of low-impact fractures (fragility fractures), hypogonadism, radiographic osteopenia or compression fracture, long-term treatment with glucocorticoids, and hyperparathyroidism.
- Effective treatments for osteoporosis now available for men, in addition to calcium and vitamin D supplements, include testosterone replacement therapy for hypogonadal men, alendronate, risendronate, and zoledronic acid for osteoporotic men, and teriparatide (for hypogonadal men or those at very high risk for fractures who are unable to take alendronate).