Osteoporosis in Men

Osteoporosis is a chronic, progressive disease characterized by low bone mass, bone deterioration, and decreased bone strength resulting in bone fragility and increased fracture risk. 1 Osteoporosis increasingly is being recognized as an important cause of morbidity and mortality in older men. Approximately 2 million men in the United States have osteoporosis, 2 and 1.5 million of these men are over the age of 65 years. 3 The risk of osteoporosis increases with age but develops in men approximately 5 to 10 years later than in women. 4 The estimated lifetime risk of developing an osteoporotic fracture after the age of 50 years is 13 % for men versus 40 % for women. 5 Between 25% and 35 % of hip fractures occur in men. 6 For reasons that are unclear, the mortality associated with hip fractures is higher in men than in women. 7 Men are twice as likely to die in the hospital following a hip fracture (14 % versus 6 % for women), 7 and it is estimated that 31 % of men with hip fracture die within 1 year of the fracture versus 17 % of women. 8 Although osteoporosis is recognized as a debilitating condition in older men and a cause of significant morbidity and mortality, it remains poorly understood and is frequently overlooked in clinical practice. As the population of men over age 65 years continues to grow, physicians in various settings are increasingly likely to encounter male patients with or at risk for osteoporosis. Early recognition of these patients is essential to achieving better outcomes of care in men with osteoporosis. This article provides an overview of osteoporosis in men, with a focus on causes and risk factors, use of dual-energy x-ray absorptiometry (DXA) for screening and diagnosis, and treatment options