Fragility fractures are a public health problem in men. Thirty percent of all hip fractures occur in men. The lifetime risk of vertebral fracture is about 15–20%. Men with spine or hip fractures have reduced bone size and reduced bone density in the smaller bones.
The pathogenesis of these deficits probably has its origins in growth as well as aging. Bone loss is the result of reduced bone formation rather than increased bone resorption.
Hypogonadism is a common and treatable cause of osteoporosis and should be excluded in men presenting with spine or hip fractures. Hypogonadism is usually idiopathic and not associated with elevated gonadotrophins; however, it may be due to primary testicular failure associated with raised gonadotrophins, Klinefelter’s disease, Kalman’s syndrome, and some other diseases.
Alcohol excess, with or without hypogonadism, is an important attributable risk factor for osteoporosis in men.
Men with spine or hip fractures may have other underlying illnesses, such as multiple myeloma, malabsorption, Cushing’s disease/syndrome, and hemochromatosis.
There has been only one clinical trial using anti-fracture efficacy as an endpoint in men. Alendronate has been reported to reduce the risk of spine fractures in men with osteoporosis. These drugs are probably the best option at the moment. Intermittent PTH administration has been reported to increase BMD in men, and evidence of anti-fracture efficacy is available but remains unpublished. Hypogonadism and the underlying cause should be treated if detected. Calcium supplementation may slow bone loss. Fluoride therapy and the active vitamin D metabolite calcitriol cannot be recommended. Vitamin D deficiency should be investigated and treated when detected. Risk factors such as excessive alcohol intake and tobacco use should be corrected.
KeywordsVertebral Fracture Anorexia Nervosa Primary Hyperparathyroidism Periosteal Apposition Bladder Neck Obstruction
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