Osteoporosis in Men

Publisher Summary Although osteoporosis has long been considered a disease of women, the earliest reports of the epidemiology of fractures associated with osteoporosis clearly showed that the classical age-related increase in fractures seen in women was also evident in men. This chapter examines the issue of osteoporosis in men and compares its pathophysiology and clinical presentation to parallel processes in women. In early childhood, there are few discernible differences between the skeletons of boys and girls. During adolescence, both sexes exhibit dramatic increases in bone mass which are closely related to pubertal stage and is almost complete when puberty ends. In boys, the achievement of peak bone mass is later, not only because puberty is later in onset but also because boys accrete bone for a longer time during this crucial period. The adolescent development of adult bone mass depends upon changes in both density and size, with increases in size being quantitatively much more important. Guidelines for the efficient, cost-effective approach for the evaluation of patients with low bone mass, or patients suspected of having low bone mass, are poorly validated for either sex. Current recommendations are therefore based on existing knowledge of the epidemiology and clinical characteristics of osteoporosis rather than upon models that have been carefully tested in prospective studies. Within these constraints, it is possible to formulate an approach to the male osteoporotic. It is derived from the more mature knowledge base available concerning osteoporosis in women, but may depart in several key areas. Therapy of osteoporotic disorders in men is relatively unexplored. There have been very few trials of osteoporosis therapies performed specifically in male populations, although some men with osteoporosis have been included in mixed populations treated with a variety of agents. In general, it is very difficult to assess independently the success of these approaches in the male subjects.