Osteoporosis in Men: A Neglected Problem
Subgroup: Volume 12, Issue 1
Date: January 2010
Type: Letter to Editor
- P Mottaghi Department of Internal Medicine, Al Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
City, Province: Isfahan,
Many consider osteoporosis to be exclusively a women’s problem, and numerous articles are published on the issue but only recently has osteoporosis in men have been paid attention and screening for it now becoming a challenging matter.1 It is true that a man with a low bone mineral density alone is less susceptible to fracture than a woman of the similar age with the similar bone mineral density, but osteoporosis in men commonly manifests with fracture whereas in women it is often diagnosed by routine bone density screening.2 The cause of most fractures in elderly men is osteoporosis and men of 50 years and older have a 13% lifetime risk for fracture.3
In a recent unpublished survey among 110 men over 50 years old referred to a bone densitometry centre, we found osteoprosis in 28.4% and osteopenia in 41% of those without clinical risk factor for osteoporosis. There are no published consensus guidelines for osteoporosis screening in men although experts in the field of osteoporosis have made some recommendations.4,5 First, men with any of the following conditions should be considered legible candidates for formal osteoporosis testing: any history of non-traumatic fracture, radiographic evidence of osteopenia, long-term glucocorticoid use, hypogonadism, hyperparathyroidism, and other risk factors for osteoporosis including disease states, medications affecting bone metabolism, or gait disorder. Second, physicians might consider routinely screening men aged 70 or older, because this is the age when fracture rates increase most rapidly.4,5
In summary, osteoporosis is a prevalent health problem in men but is currently underestimated by patients and under-treated by physicians.
Conflict of interest: None declared.
- Olszynski WP, Shawn Davison K, Adachi JD, Brown JP, Cummings SR, Hanley DA, Harris SP, Hodsman AB, Kendler D, McClung MR, Miller PD, Yuen CK. Osteoporosis in men: epidemiology, diagnosis, prevention, and treatment. Clin Ther 2004;26:15-28.  [doi:10.1016/S0149-2918(04)90002-1]
- Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH. Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med 2002;162:2217-22.  [doi:10.1001/archinte.162.19.2217]
- Schuit SC, van der Klift M, Weel AE, de Laet CE, Burger H, Seeman E, Hofman A, Uitterlinden AG, van Leeuwen JP, Pols HA. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone 2004;34:195-202.  [doi:10.1016/j.bone.2003.10.001]
- Liu H, Paige NM, Goldzweig CL, Wong E, Zhou A, Suttorp MJ, Munjas B, Orwoll E, Shekelle P. Screening for osteoporosis in men: a systematic review for an American College of Physicians guideline. Ann Intern Med 2008;148:685-701. 
- Behroozi D. Screening men for osteoporosis. CMAJ 2007;177:1069.  [doi:10.1503/cmaj.1070018]