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Review

Osteoporosis in Men

In: Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000.
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Review

Osteoporosis in Men

Robert A. Adler.
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Excerpt

While progress has been made, osteoporosis in men is still under-diagnosed and under-treated. In general, men fracture about 10 years later than women, with large increases in fracture risk after about age 75, although a small number of men may present with vertebral fractures in middle age. There is overlap between secondary causes of osteoporosis and risk factors for primary osteoporosis, but men with fragility fractures or low bone density require evaluation by history and physical examination as well as a short list of laboratory tests. Bone mineral density by dual-energy x-ray absorptiometry remains the best test for diagnosing osteoporosis in men, although opportunistic bone density measurements from CT scans are promising. Clinicians should recommend a comprehensive program of treatment with fall risk reduction, attention to diet and vitamin D status, and pharmacologic treatment. In general, medications that work in women should lead to fewer fractures in men, although there are few studies in men with fracture risk reduction as the primary outcome. Most men with osteoporosis should be treated with oral or intravenous bisphosphonates, but men at very high fracture risk should be considered for initial anabolic treatment. Compared to women, men are more likely to die after hip fracture. The long-term management of men with osteoporosis is based solely on a few studies in women. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.

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