QJM, Vol 91, Issue 2 71-92, Copyright © 1998 by Oxford University Press
R Eastell, IT Boyle, J Compston, C Cooper, I Fogelman, RM Francis, DJ Hosking, DW Purdie, S Ralston, J Reeve, DM Reid, RG Russell and JC Stevenson
Although osteoporosis is generally regarded as a disease of women, up to
30% of hip fractures and 20% of vertebral fractures occur in men. Risk
factors for osteoporotic fractures in men include low body mass index,
smoking, high alcohol consumption, corticosteroid therapy, physical
inactivity, diseases that predispose to low bone mass, and conditions
increasing the risk of falls. The key drugs and diseases that definitely
produce a decrease in bone mineral density (BMD) and/or an increase in
fracture rate in men are long-term corticosteroid use, hypogonadism,
alcoholism and transplantation. Age-related bone loss may be a result of
declining renal function, vitamin D deficiency, increased parathyroid
hormone levels, low serum testosterone levels, low calcium intake and
absorption. Osteoporosis can be diagnosed on the basis of radiological
assessments of bone mass, or clinically when it becomes symptomatic.
Various biochemical markers have been related to bone loss in healthy and
osteoporotic men. Their use as diagnostic tools, however, needs further
investigation. A practical approach would be to consider a bone density
more than one SD below the age-matched mean value (Z < -1) as an
indication for therapy. The treatment options for men with osteoporosis
include agents to influence bone resorption or formation and specific
therapy for any underlying pathological condition. Testosterone treatment
increases BMD in hypogonadal men, and is most effective in those whose
epiphyses have not closed completely. Bisphosphonates are the treatment of
choice in idiopathic osteoporosis, with sodium fluoride and anabolic
steroids to be used as alternatives.
REVIEWS
Management of male osteoporosis: report of the UK Consensus Group
University of Sheffield Medical School, UK.
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