Osteoporosis in males

Background: Osteoporotic fractures occur frequently also in men. Epidemiolo gic from Germany indicate that more than 900,000 men are affected by osteop orotic fractures. Diagnosis and therapy of male osteoporosis are hampered b y a lack of clinical studies. Diagnosis: Risk factor analysis, conventional spine X-rays, bone densitomet ry and a limited number of serum and urine analyses contribute to the diagn osis of osteoporosis and the assessment of future fracture risk. Bone densi tometry at the femoral neck is superior to measurements at the lumbar spine because of the high prevalence of degenerative changes at the lumbar spine in elderly men. Major risk factors for osteoporosis are hypogonadism, gluc ocorticoid therapy, hypercalciuria, gastrointestinal disease, and high alco hol consumption. In individual cases, bone histology or additional biochemi cal studies are needed to establish the cause of osteoporosis. Therapy: Calcium and vitamin D deficits should be substituted both in preve ntion treatment of male osteoporosis. Testosterone replacement therapy is e ffective in hypogonadism. In primary osteoporosis and in corticosteroid-ind uced osteoporosis, bisphosphonates (cyclical etidronate, alendronate) and f luorides are therapeutic options. Conclusion: Important principles in the care of men with osteoporosis are t he transfer of knowledge established for postmenopausal osteoporosis and th e rigorous search for secondary osteoporosis aiming at treatment of the und erlying cause. Large prospective randomized trials aiming at the reduction of fracture rate in male osteoporosis are missing. They are urgently needed .