Pharmacotherapy of osteoporosis in men

Osteofragility fractures occur in men due to a compromise in bone strength, coupled with either trauma or a fall. In men greater than or equal to 65 years of age, osteoporosis can be defined as bone mineral density (at the proximal femur, spine or distal forearm) of 2.5 standard deviations or less below the mean for a normal young adult man, using a male reference database (i.e., T-score value of less than or equal to -2.5) ([1,2]). In men 50 - 65 years of age, a similar definition is used if other risk factors for a fracture are present. Osteoporosis is increasingly recognised in men ([3-11]). One in three men aged > 60 years will suffer an osteoporotic fracture ([3]). Spinal fractures occur in 5% of men (compared with 16% of women) and hip fractures in 6% of men (compared with 18% of women) > 50 years of age ([8]). The risk of hip fracture increases by similar to 2.6-fold for each standard deviation decrease in bone density measured at the hip ([12,13]). At present, the life expectancy for men has increased to a mean age of 76.8 years. With men now living longer, they can be expected to develop multiple coexisting illnesses contributing to bone loss and an increased likelihood of failing and fragility fractures ([5,14,15]). It is estimated that 30 - 60% of men presenting with spinal fractures have another illness contributing to their bone disease ([4,6-10,16-20]). The ideal therapy for men with osteoporosis should include an intervention which significantly increases bone strength and reduces fracture rates, is safe, easy to administer and economical. This review outlines the current treatment strategies available for men with osteoporosis.