Update in male osteoporosis

Abstract

Context: Osteoporosis in men is becoming an increasingly important public health problem. One in five men over the age of 50 yr will suffer an osteoporotic fracture during their lifetime, and men who sustain fractures have an increased mortality risk.

Evidence acquisition: Evidence was obtained by PubMed search and author's knowledge of the field.

Evidence synthesis: Studies using computed quantitative tomography and high-resolution peripheral computed quantitative tomography have provided new insights into the bone structural changes with aging in men, including the somewhat surprising demonstration of significant, ongoing trabecular bone loss starting in young adult life. In addition, there are now data demonstrating that serum estradiol levels are important predictors of fracture risk in men and that there is a threshold estradiol level below which not only bone loss but also fracture risk increases markedly. Criteria for diagnosing and managing osteoporosis in men are also evolving, including the application of the fracture risk assessment tool to derive 10-yr fracture risks in men. Three bisphosphonates (alendronate, risedronate, and zolendronic acid) and teriparatide are currently U.S. Food and Drug Administration approved for the treatment of osteoporosis in men, with a number of new compounds, including a monoclonal antibody against receptor activator of nuclear factor-kappaB ligand, selective estrogen receptor modulators, and selective androgen receptor modulators in varying stages of development.

Conclusions: Despite significant advances, there remain a number of key unresolved issues regarding the pathogenesis and management of male osteoporosis, not the least of which is increasing public awareness of this important cause of morbidity and mortality in men.

Figure 1

Mortality rates for the general participants and fracture patients according to age from the Dubbo Osteoporosis Epidemiology Study in women (A) and men (B). In this population, there were 2245 women and 1760 men aged 60 yr and older. Of the fracture patients, 952 were women and 343 were men. Error bars indicate 95% CI. [Reproduced with permission from D. Bliuc et al.: JAMA 301:513, 2009 (10). ©American Medical Association.]

Figure 2

Age-specific rates of change in vBMD at trabecular scanning sites in men at the distal radius (A), distal tibia (B), and lumbar spine (C). Data are shown with a smoothing spline and the 95% CI. [Reproduced with permission from B. L. Riggs et al.: J Bone Miner Res 23:205, 2008 (15). ©American Society for Bone and Mineral Research.]

Figure 3

Age-specific changes in vBMD at cortical scanning sites at distal radius (A) and distal tibia (B) in men. Data are shown with a smoothing spline and the 95% CI. [Reproduced with permission from B. L. Riggs et al.: J Bone Miner Res 23:205, 2008 (15). ©American Society for Bone and Mineral Research.]

Figure 4

Yearly incidence of fractures as a function of serum estradiol levels in subjects from MrOS Sweden. Poisson regression models were used to determine the relation between serum estradiol levels and fracture risk. [Reproduced with permission from Mellström et al.: J Bone Miner Res 23:1552, 2008 (27). ©American Society for Bone and Mineral Research.]