IBMS BoneKEy | Perspective

Pathophysiology and diagnosis of osteoporosis in aging men

Pawel Szulc

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DOI:10.1138/20080342

Abstract

Osteoporotic fractures in older men are a major public health problem due to their morbidity, mortality and costs. Older men have a lower fracture risk than age-matched women for several reasons. Young men have larger bones than women even after adjustment for differences in body size. Age-related cortical thinning is lower in magnitude in men than in women because in men, endocortical expansion is more efficiently offset by periosteal apposition. The principal mechanism of trabecular bone loss in men is trabecular thinning in contrast to trabecular perforation and loss in women.

The definition and the diagnostic criteria of osteoporosis in men are still subject to debate and controversy. In men aged 50 and older, osteoporosis may be diagnosed if the sex-specific T-score of the lumbar spine, total hip, or femoral neck is -2.5 or less. In certain circumstances, the one-third distal radius may also be utilized. Assessment of clinical risk factors can help clinicians identify asymptomatic men at risk for low bone mineral density (BMD). For instance, in men with prostate cancer, both surgical bilateral orchidectomy and androgen-deprivation therapy result in rapid bone loss and high risk of fracture. The fracture risk assessment tool (FRAX®) helps identify individuals at high risk of fracture on the basis of several clinical criteria associated with an increased fracture risk regardless of BMD. Especially in the elderly, the assessment of the risk of fracture must include assessment of the risk of falls.

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