Osteoporosis in men

Osteoporosis has been a disorder almost synonymously associated with women, and as a result the understanding of osteoporosis in men is rudimentary. Nevertheless, there is an emerging recognition of the impact of osteoporosis in men, and the recent tremendous increase in knowledge of the disorder in women should provide a foundation for rapid advances in parallel areas in men. Attention should be focused on elucidating the causation of age-related bone loss and the clinical character and pathophysiology of idiopathic male osteoporosis. Of particular importance are efforts to understand the basic nature of sexual differences in skeletal development and maturation, with the aim of identifying aspects of male skeletal metabolism that require gender-specific clinical consideration. In addition, by understanding the mechanisms underlying the relative fracture prevention afforded the male skeleton, new therapy for both sexes may become possible. Even in advance of the understanding of these basic processes, appropriate clinical paradigms for the evaluation of osteoporosis in men should be developed and validated, and clinical trials of promising approaches to the prevention and treatment of osteoporosis in men need to be undertaken. These should certainly include evaluations of exercise, calcium supplementation, androgen supplementation, and formation and antiresorptive therapies. As newer therapeutic approaches are developed in the future, clinical studies should include male cohorts from their inception.