Osteoporosis in men

Osteoporosis in men has become much more prominent as its prevalence and impact have become apparent. Fractures in men are common and of great importance to both individuals and society. Although in many ways the character of osteoporosis in men is similar to that in women, there are important differences as well. For instance, the rate of morbidity and mortality after a hip fracture s greater in men, probably because of more concomitant illness. The causation of osteoporosis in men and the approach to diagnosis are also somewhat different. Of particular importance is the impact of gonadal insufficiency and the relative roles of androgens and estrogen in male skeletal health. Apparently both sex steroids are essential, but the mechanisms by which each affects bone metabolism are unclear. Approaches to the prevention and therapy of osteoporosis in men have been developed. Evidence supports the effectiveness of vitamin D and calcium supplementation, and bisphosphonates are effective in preventing bone loss and fractures in several situations. New therapies (parathyroid hormone, selective estrogens and androgens) are on the horizon. (C) 2000 Lippincott Williams and Wilkins, Inc.