Osteoporosis and osteoporotic fractures in men: a clinical perspective

The lifetime risk of any fracture of the hip, spine or distal forearm in me n aged 50 years has been estimated to be 13%, compared with 40% in women. A lthough the overall incidence of osteoporosis is less in men than in women, the disease still represents an important public health problem. In partic ular, hip fractures are associated with substantial mortality and morbidity , even more so than in women. In male patients presenting with osteoporotic fractures, major causes of skeletal fragility, such as hypogonadism, gluco corticoid excess, primary hyperparathyroidism and alcohol abuse, can often be identified. In as many as 50% of osteoporotic men, however, no aetiology can be round: these men suffer from a syndrome commonly referred to as idi opathic osteoporosis, which is presumably related to some type of osteoblas t dysfunction. Recent evidence indicates that the loss of skeletal integrit y in ageing men may be partially related to endocrine deficiencies, includi ng vitamin D, androgen and/or oestrogen deficiency. While the consequences of vitamin D or oestrogen deficiency in women have been well established, t he skeletal impact of these (partial) age-related deficiencies in men remai ns to be clarified. Osteoporosis in elderly men is a multifactorial disease , as it is in women. The prevention of osteoporosis should therefore focus not only on increasing the bone strength, but also on decreasing the risk o f falls. However, the prevention and therapy of osteoporotic disorders in m en are virtually unexplored. To date, the use of specific osteoporotic drug s in osteoporotic men is still based on reasonable but untested assumptions .