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Review Article| Volume 37, ISSUE 3, P401-414, August 2011

Osteoporosis in Men: Update 2011

  • Denise L. Orwig
    Correspondence
    Corresponding author.
    Affiliations
    Department of Epidemiology and Public Health, School of Medicine, University of Maryland, 660 West Redwood Street, Suite 200, Baltimore, MD 21201, USA
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  • Nancy Chiles
    Affiliations
    Department of Epidemiology and Public Health, School of Medicine, University of Maryland, 660 West Redwood Street, Suite 200, Baltimore, MD 21201, USA

    Doctoral Program in Gerontology, School of Medicine, University of Maryland Baltimore and Baltimore County, 660 West Redwood Street, Suite 200, Baltimore, MD 21201, USA
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  • Mark Jones
    Affiliations
    Department of Epidemiology and Public Health, School of Medicine, University of Maryland, 660 West Redwood Street, Suite 200, Baltimore, MD 21201, USA

    Epidemiology Doctoral Program, School of Medicine, University of Maryland, 660 West Redwood Street, Suite 200, Baltimore, MD 21201, USA
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  • Marc C. Hochberg
    Affiliations
    Department of Medicine, School of Medicine, University of Maryland, 10 South Pine Street, MSTF 8-34, Baltimore, MD 21201, USA
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      Keywords

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      References

        • Adler R.A.
        Osteoporosis in men: what has changed?.
        Curr Osteoporos Rep. 2011; 9: 31-35
        • Khosla S.
        Update in male osteoporosis.
        J Clin Endocrinol Metab. 2010; 95: 3-10
        • Ryan C.
        • Petkov V.I.
        • Adler R.A.
        Osteoporosis in men: the value of laboratory testing.
        Osteoporos Int. 2011; 22: 1845-1853
        • Looker A.C.
        • Melton III, L.J.
        • Harris T.B.
        • et al.
        Prevalence and trends in low femur bone density among older US adults: NHANES 2005-2006 compared with NHANES III.
        J Bone Miner Res. 2010; 25: 64-71
        • Finkelstein J.S.
        Epidemiology and etiology of osteoporosis in men.
        UpToDate, 2010 (Available at:) (Accessed December 28, 2010)
        • Finkelstein J.S.
        Diagnosis and evaluation of osteoporosis in men.
        UpToDate, 2010 (Available at:) (Accessed December 28, 2010)
        • Finkelstein J.S.
        Treatment of osteoporosis in men.
        UpToDate, 2010 (Available at:) (Accessed December 28, 2010)
        • World Health Organization
        Assessment of fracture risk and application to screening for postmenopausal osteoporosis.
        World Health Organization, Geneva (Switzerland)1994
      1. National Osteoporosis Foundation. America’s bone health: the state of osteoporosis and low bone mass. Available at: http://www.nof.org/advocacy/prevalence. Accessed May 1, 2005.

        • Dawson-Hughes B.
        • Looker A.C.
        • Tosteson N.A.
        • et al.
        The potential impact of new National Osteoporosis Foundation guidance on treatment patterns.
        Osteoporos Int. 2010; 21: 41-52
        • Berry S.
        • Kiel D.P.
        • Donaldson M.G.
        • et al.
        Application of the National Osteoporosis Foundation Guidelines to postmenopausal women and men: the Framingham Osteoporosis Study.
        Osteoporos Int. 2010; 21: 53-60
        • Morris C.
        • Cabral D.
        • Cheng H.
        • et al.
        Patterns of bone mineral density testing: current guidelines, testing, rates, and interventions.
        J Gen Intern Med. 2004; 19: 783-790
      2. Centers for Medicare and Medicaid Services. Bone Mass Measurement: Overview. 2011. Available at: http://www.cms.gov/BoneMassMeasurement/. Accessed August 10, 2011.

        • Lane J.
        • Serota A.C.
        • Raphael B.
        Osteoporosis: differences and similarities in male and female patients.
        Orthop Clin North Am. 2006; 37: 601-609
        • Nguyen N.
        • Ahlborg H.G.
        • Center J.R.
        • et al.
        Residual lifetime risk of fractures in women and men.
        J Bone Miner Res. 2007; 22: 781-788
        • Thomas-John M.
        • Codd M.B.
        • Manne S.
        • et al.
        Risk factors for the development of osteoporosis and osteoporotic fractures among older men.
        J Rheumatol. 2009; 36: 1947-1952
        • Burge R.
        • Dawson-Hughes B.
        • Solomon D.H.
        • et al.
        Incidence and economic burden of osteoporosis-related fractures in the United States.
        J Bone Miner Res. 2007; 22: 465-475
        • Ray N.F.
        • Chan J.K.
        • Thamer M.
        • et al.
        Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation.
        J Bone Miner Res. 1997; 12: 24-35
      3. DeFrances CJ, Podgornik MN. 2004 National Hospital Discharge Survey: Annual Summary with detailed diagnosis and procedure data. Advance data from vital and health statistics. Hyattsville (MD): National Center for Health Statistics; 2006. Available at: http://www.cdc.gov/nchs/data/ad/ad371.pdf. Accessed August 10, 2011.

        • Melton III, L.
        • Orwoll E.
        • Wasnich R.
        Does bone density predict fractures comparably in men and women?.
        Osteoporos Int. 2001; 12: 707-709
        • Chang K.P.
        • Center J.R.
        • Nguyen T.V.
        • et al.
        Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo Osteoporosis Epidemiology Study.
        J Bone Miner Res. 2004; 19: 532-536
        • Haentjens P.
        • Johnell O.
        • Kanis J.A.
        • et al.
        Evidence from data searches and life-table analyses for gender-related differences in absolute risk of hip fracture after Colles' or spine fracture: Colles' fracture as an early and sensitive marker of skeletal fragility in white men.
        J Bone Miner Res. 2004; 19: 1933-1944
        • Melton 3rd, L.J.
        • Kearns A.E.
        • Atkinson E.J.
        • et al.
        Secular trends in hip fracture incidence and recurrence.
        Osteoporos Int. 2008; 20: 687-694
        • Cummings S.R.
        BMD and risk of hip and nonvertebral fractures in older men: a prospective study and comparison with older women.
        J Bone Miner Res. 2006; 21: 1550
        • Bass E.
        • French D.D.
        • Bradham D.D.
        • et al.
        Risk-adjusted mortality rates of elderly veterans with hip fractures.
        Ann Epidemiol. 2007; 17: 514-519
        • Endo Y.
        • Aharonoff G.B.
        • Zuckerman J.D.
        • et al.
        Gender differences in patients with hip fracture: a greater risk of morbidity and mortality in men.
        J Orthop Trauma. 2005; 19: 29-35
        • Penrod J.
        • Litke A.
        • Hawkes W.G.
        • et al.
        The association of race, gender, and comorbidity with mortality and function after hip fracture.
        J Gerontol A Biol Sci Med Sci. 2008; 63A: 867-872
        • Colon-Emeric C.
        • Kuchibhatla M.
        • Pieper C.
        • et al.
        The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies.
        Osteoporos Int. 2003; 14: 879-883
        • Bischoff H.A.
        • Solomon D.H.
        • Dawson-Hughes B.
        • et al.
        Repeat hip fractures in a population-based sample of Medicare recipients in the US: timing and gender differences [abstract].
        J Bone Miner Res. 2001; 16 (S213)
        • Magaziner J.
        • Lydick E.
        • Hawkes W.
        • et al.
        Excess mortality attributable to hip fracture in white women aged 70 years and older.
        Am J Public Health. 1997; 87: 1630-1636
        • Hawkes W.G.
        • Wehren L.
        • Orwig D.
        • et al.
        Gender differences in functioning after hip fracture.
        J Gerontol A Biol Sci Med Sci. 2006; 61A: 495-499
        • Dennison E.
        • Jameson K.A.
        • Syddall H.E.
        • et al.
        Bone health and deterioration in quality of life among participants from the Hertfordshire Cohort Study.
        Osteoporos Int. 2010; 21: 1817-1824
        • Heaney R.P.
        • Abrams S.
        • Dawson-Hughes B.
        • et al.
        Peak bone mass.
        Osteoporos Int. 2000; 11: 985-1009
        • McGuigan F.
        • Murray L.
        • Gallagher A.
        • et al.
        Genetic and environmental determinants of peak bone mass in young men and women.
        J Bone Miner Res. 2002; 17: 1273-1279
        • Cummings S.R.
        Bone biology, epidemiology, and general principles.
        in: Cummings S.R. Cosman F. Jamal S. Osteoporosis: an Evidence-based Guide to Prevention and Management. American College of Physicians, Philadelphia (PA)2002: 3-25
        • Seeman E.
        • Delmas P.D.
        Bone quality – the material and structural basis of bone strength and fragility.
        New Engl J Med. 2006; 354: 2250-2261
        • Hannan M.T.
        • Felson D.T.
        • Dawson-Hughes B.
        • et al.
        Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study.
        J Bone Miner Res. 2000; 15: 710-720
        • Amin S.
        Male osteoporosis: epidemiology and pathophysiology.
        Curr Osteoporos Rep. 2003; 1: 71-77
        • Riggs B.
        • Khosla S.
        • Melton 3rd, L.J.
        Sex steroids and the construction and conservation of the adult skeleton.
        Endocr Rev. 2002; 23: 279-302
        • Cauley J.
        • Lui L.Y.
        • Stone K.L.
        • et al.
        Longitudinal study of changes in hip bone mineral density in Caucasian and African-American women.
        J Am Geriatr Soc. 2005; 53: 183-189
        • Tracy J.K.
        • Meyer W.A.
        • Flores R.H.
        • et al.
        Racial differences in rate of decline in bone mass in older men: the Baltimore Men's Osteoporosis Study.
        J Bone Miner Res. 2005; 20: 1228-1234
        • Papaioannou A.
        • Kennedy C.C.
        • Cranney A.
        • et al.
        Risk factors for low BMD in healthy men age 50 years or older: a systematic review.
        Osteoporos Int. 2009; 20: 507-518
        • Naves M.
        • Diaz-Lopez J.G.
        • Gomez C.
        • et al.
        Prevalence of osteoporosis in men and determinants of changes in bone mass in a non-selected Spanish population.
        Osteoporos Int. 2005; 16: 603-609
        • Bakhireva L.
        • Barrett-Connonr E.
        • Kritz-Silverstein D.
        • et al.
        Modifiable predictors of bone loss in older men: a prospective study.
        Am J Prev Med. 2004; 26: 436-442
        • Scholtissen S.
        • Guillemin F.
        • Bruyere O.
        • et al.
        Assessment of determinants for osteoporosis in elderly men.
        Osteoporos Int. 2009; 20: 1157-1166
        • Lewis C.
        Predictors of non-spine fracture in elderly men: the MrOS Study.
        J Bone Miner Res. 2007; 22: 211
        • Greenspan S.
        • Coates P.
        • Sereika S.M.
        • et al.
        Bone loss after initiation of androgen deprivation therapy in patients with prostate cancer.
        J Clin Endocrinol Metab. 2005; 90: 6410-6417
      4. Campion J, Maricic MJ. Osteoporosis in men. 2003. Available at: http://www.aafp.org/afp/2003/0401/p1521.html. Accessed August 10, 2011.

        • Meier C.
        • Nguyen T.V.
        • Handelsman D.J.
        • et al.
        Endogenous sex hormones and incident fracture risk in older men. The Dubbo Osteoporosis Epidemiology Study.
        Arch Intern Med. 2008; 168: 47-54
        • Falahati-Nini A.
        • Riggs B.L.
        • Atkinson E.J.
        • et al.
        Relative contributions of testosterone and estrogen in regulating bone resorption and formation in normal elderly men.
        J Clin Invest. 2000; 106: 1553-1560
        • Venken K.
        • Callewaert F.
        • Boonen S.
        • et al.
        Sex hormones, their receptors, and bone health.
        Osteoporos Int. 2008; 19: 1517-1525
        • Amin S.
        • Zhang Y.
        • Felson D.T.
        • et al.
        Estradiol, testosterone, and the risk for hip fracture in elderly men from the Framingham Study.
        Am J Med. 2006; 119: 426-433
        • LeBlanc E.
        • Nielson C.M.
        • Marshall L.M.
        • et al.
        The effects of serum testosterone, estradiol, and sex hormone binding globulin levels on fracture risk in older men.
        J Clin Endocrinol Metab. 2009; 94: 3337-3346
        • George A.
        • Tracy J.K.
        • Meyer W.A.
        • et al.
        Racial differences in bone mineral density in older men.
        J Bone Miner Res. 2003; 18: 2238-2244
        • Chiu G.
        • Araujo A.B.
        • Travison T.G.
        • et al.
        Relative contributions of multiple determinants to bone mineral density in men.
        Osteoporos Int. 2009; 20: 2035-2047
        • Baim S.
        • Binkley N.
        • Bilezikian J.P.
        • et al.
        Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference.
        J Clin Densitom. 2008; 11: 75-91
        • Qaseem A.
        • Snow V.
        • Shekelle P.
        • et al.
        Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening for osteoporosis in men: a clinical practice guideline Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians.
        Ann Intern Med. 2008; 148: 680-684
      5. Shekelle P, Munjas B, Liu H, et al. Screening men for osteoporosis: who & how. Available at: http://www.ncbi.nlm.nih.gov/books/NBK49063/. Accessed August 9, 2011.

        • Liu H.
        • Paige N.M.
        • Goldzweig C.L.
        • et al.
        Screening for osteoporosis in men: a systematic review for an American College of Physicians Guideline.
        Ann Intern Med. 2008; 148: 685-701
      6. Nelson HD, Haney EM, Chou R, et al. Screening for osteoporosis: Systematic Review to Update the 2002 U.S. Preventive Services Task Force Recommendation. 2010. Available at: http://www.ncbi.nlm.nih.gov/books/NBK45201/. Accessed August 9, 2011.

      7. Department of Veterans Affairs VHA. 2009. Available at: http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2083. Accessed August 9, 2011.

        • Petzel R.A.
        Undersecretary for Health's Information Letter. Osteoporosis in Men.
        Department of Veterans Affairs, Veterans Health Administration, Washington, DC2011
        • Vermeulen A.
        • Kaufman J.M.
        Ageing of the hypothalamo-pituitary-testicular axis in men.
        Horm Res. 1995; 43: 25-28
      8. Faiman C. Male Hypogonadism. 2009. Available at: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/male-hypogonadism/. Accessed August 9, 2011.

        • Finkelstein J.
        • Klibanski A.
        • Neer R.M.
        • et al.
        Osteoporosis in men with idiopathic hypogonadotropic hypogonadism.
        Ann Intern Med. 1987; 106: 354-361
        • Stoch S.
        • Parker R.A.
        • Chen L.
        • et al.
        Bone loss in men with prostate cancer treated with gonadotropin-releasing hormone agonists.
        J Clin Endocrinol Metab. 2001; 86: 2787-2791
        • Diamond T.
        • Stiel D.
        • Posen S.
        Osteoporosis in hemochromatosis: iron excess, gonadal deficiency, or other factors?.
        Ann Intern Med. 1989; 110: 430-436
        • Katznelson L.
        • Finkelstein J.S.
        • Schoenfeld D.A.
        • et al.
        Increase in bone density and lean body mass during testosterone administration in men with acquired hypogonadism.
        J Clin Endocrinol Metab. 1996; 81: 4358-4365
        • Behre H.
        • Kliesch S.
        • Leifke E.
        • et al.
        Long-term effect of testosterone therapy on bone mineral density in hypogonadal men.
        J Clin Endocrinol Metab. 1997; 82: 2386-2390
        • Finkelstein J.
        • Klibanski A.
        • Neer R.M.
        • et al.
        Increases in bone density during treatment of men with idiopathic hypogonadotropic hypogonadism.
        J Clin Endocrinol Metab. 1989; 69: 776-783
        • Abbasi A.
        • Rudman D.
        • Wilson C.R.
        • et al.
        Observations on nursing home residents with a history of hip fracture.
        Am J Med Sci. 1995; 310: 229-234
        • Scane A.
        • Sutcliffe A.M.
        • Francis R.M.
        Osteoporosis in men.
        Bailliere's Clin Rheumatol. 1993; 7: 589-601
        • Guo C.
        • Jones T.H.
        • Eastell R.
        Treatment of isolated hypogonadotropic hypogonadism effect on bone mineral density and bone turnover.
        J Clin Endocrinol Metab. 1997; 82: 658-665
        • Finkelstein J.
        • Neer R.M.
        • Biller B.M.
        • et al.
        Osteopenia in men with a history of delayed puberty.
        N Engl J Med. 1992; 326: 600-604
        • Finkelstein J.
        • Klibanski A.
        • Neer R.M.
        A longitudinal evaluation of bone mineral density in adult men with histories of delayed puberty.
        J Clin Endocrinol Metab. 1996; 81: 1152-1155
        • Bertelloni S.
        • Baroncelli G.I.
        • Battini R.
        • et al.
        Short-term effect of testosterone treatment on reduced bone density in boys with constitutional delay of puberty.
        J Bone Miner Res. 1995; 10: 1488-1495
        • Araujo A.B.
        • Travison T.G.
        • Harris S.S.
        • et al.
        Race/ethnic differences in bone mineral density in men.
        Osteoporos Int. 2007; 18: 943-953
        • Slemenda C.
        • Longcope C.
        • Zhou L.
        • et al.
        Sex steroids and bone mass in older men: positive associations with serum estrogens and negative associations with androgens.
        J Clin Invest. 1997; 100: 1755-1759
        • Khosla S.
        • Melton 3rd, L.J.
        • Atkinson E.J.
        • et al.
        Relationship of serum sex steroid levels and bone turnover markers with bone mineral denstiy in men and women: a key role for bioavailable estrogen.
        J Clin Endocrinol Metab. 1998; 83: 2266-2274
        • Ongphiphadhanakul B.
        • Rajatanavin R.
        • Chanprasertyothin S.
        • et al.
        Serum oestradiol and oestrogen-receptor gene polymorphism are associated with bone mineral density independently of serum testosterone in normal males.
        Clin Endocrinol. 1998; 49: 803-809
        • Center J.
        • Nguyen T.V.
        • Sambrook P.N.
        • et al.
        Hormonal and biochemical parameters in the determination of osteoporosis in elderly men.
        J Clin Endocrinol Metab. 1999; 84: 3626-3635
        • Greendale G.
        • Edelstein S.
        • Barrett-Connor E.
        Endogenous sex steroids and bone mineral density in older women and men: the Rancho Bernardo Study.
        J Bone Miner Res. 1997; 12: 1833-1843
        • Amin S.
        • Zhang Y.
        • Sawin C.T.
        • et al.
        Association of hypogonadism and estradiol levels with bone mineral density in elderly men from the Framingham Study.
        Ann Intern Med. 2000; 133: 951-963
        • Araujo A.
        • Travison T.G.
        • Leder B.Z.
        • et al.
        Correlations between serum testosterone, estradiol, and sex hormone-binding globulin and bone mineral density in a diverse sample of men.
        J Clin Endocrinol Metab. 2008; 93: 2135-2141
        • Meier D.
        • Orwoll E.S.
        • Keenan E.J.
        • et al.
        Marked decline in trabecular bone mineral content in healthy men with age: lack of association with sex steroid levels.
        J Am Geriatr Soc. 1987; 35: 189-197
        • Rudman D.
        • Drinka P.J.
        • Wilson C.R.
        • et al.
        Relations of endogenous anabolic hormones and physical activity to bone mineral density and lean body mass in elderly men.
        Clin Endocrinol. 1994; 40: 653-661
        • Fink H.
        • Ewing S.K.
        • Ensrud K.E.
        • et al.
        Association of testosterone and estradiol deficiency with osteoporosis and rapid bone loss in older men.
        J Clin Endocrinol Metab. 2006; 91: 3908-3915
        • Mellstrom D.
        • Johnell O.
        • Ljunggren O.
        • et al.
        Free testosterone is an independent predictor of BMD and prevalent fractures in elderly men: MrOS Sweden.
        J Bone Miner Res. 2006; 21: 529-535
        • Ensrud K.
        • Lewis C.E.
        • Lambert L.C.
        • et al.
        Osteoporotic Fractures in Men MrOS Study Research Group. Endogenous sex steroids, weight change and rates of hip bone loss in older men: the MrOS study.
        Osteoporos Int. 2006; 17: 1329-1336
      9. Nayak S, Liu H, Michaud K, et al. Cost-effectivess of alternative screening strategies for osteoporosis in postmenopausal women. 2006; Available at: http://smdm.confex.com. Accessed August 10, 2011.

        • Schousboe J.
        • Ensrud K.E.
        • Nyman J.A.
        • et al.
        Universal bone densitometry, screening combined with alendronate therapy for those diagnosed with osteoporosis in highly cost-effective for elderly women.
        J Am Geriatr Soc. 2005; 53: 1697-1704
        • Schousboe J.
        • Taylor B.C.
        • Fink H.A.
        • et al.
        Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men.
        JAMA. 2007; 298: 629-637
        • Bolland M.
        • Grey A.B.
        • Gamble G.D.
        • et al.
        Effect of osteoporosis treatment on mortality: a meta-analysis.
        J Clin Endocrinol Metab. 2010; 95: 1174-1181
      10. National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. 2008. Available at: http://www.nof.org/sites/default/files/pdfs/NOF_Clinicians_Guide2008.pdf, 2011. Accessed August 10, 2011.

        • Curtis J.
        • Adachi J.D.
        • Saag K.G.
        Bridging the osteoporosis quality chasm.
        J Bone Miner Res. 2009; 24: 3-7
        • Papaioannou A.
        • Kennedy C.C.
        • Loannidis G.
        • et al.
        The osteoporosis care gap in men with fragility fractures: the Canadian Multicenter Osteoporosis Study.
        Osteoporos Int. 2008; 19: 581-587
        • Kiebzak G.M.
        • Beinart G.A.
        • Perser K.
        • et al.
        Undertreatment of osteoporosis in men with hip fracture.
        Arch Intern Med. 2002; 162: 2217-2222
      11. Force AHT. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients - 2002 update. 2002. Available at: http://www.touchgroupplc.com/pdf/790/2-aacehtf.pdf. Accessed August 10, 2011.

        • Arisaka O.
        • Arisaka M.
        • Nakayama Y.
        • et al.
        Effect of testosterone on bone density and bone metabolism in adolescent male hypogonadism.
        Metabolism. 1995; 44: 419-423
        • van der Werff ten Bosch J.J.
        • Bot A.
        Some skeletal dimensions of males with isolated gonadotrophin deficiency.
        Neth J Med. 1992; 41: 259-263
        • Adler R.A.
        • Hochberg M.C.
        Glucocorticoid-induced osteoporosis in men.
        Endocrinol Invest. 2011; 34: 481-484
        • Grossman J.M.
        • Gordon R.
        • Ranganath V.K.
        • et al.
        American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis.
        Arthritis Care Res (Hoboken). 2010; 62: 1515-1526
        • Reid I.R.
        • Wattie D.J.
        • Evans M.C.
        • et al.
        Testosterone therapy in glucocorticoid-treated men.
        Arch Intern Med. 1996; 15: 1173-1177