Osteoporosis in older men

The incidence of osteoporotic hip and vertebral fractures rises exponentially in men older than 75 years of age. However, as is the case in women, osteoporosis in men continues to be under-diagnosed and the majority of men with minimal trauma fractures are not being treated. Successful osteoporosis management in men includes the identification of relevant risk factors for osteoporotic fracture, and the exclusion of secondary causes of bone loss, such as alcohol abuse, hypogonadism and glucocorticoid excess. Pharmacotherapy is indicated in men with prevalent/incident minimal trauma fractures or low bone mineral density (e.g., T-score at any site below -2 or -2.5). Current pharmacological treatments include antiresorptive agents such as bisphosphonates, or bone-anabolic drugs, such as teriparatide. However, larger studies are required to determine effects of oral or intravenous bisphosphonates on nonvertebral and/or hip fractures in men with osteoporosis. Androgen deficiency is common in men with osteoporosis and primarily requires testosterone replacement.