Male Osteoporosis

Abstract

Osteoporosis is an increasingly prevalent disease with important clinical, economic, and social consequences, characterized by reduced bone strength, due to altered bone density and quality, which increases the risk of spontaneous and traumatic fractures and related disabilities. Since the bone is an active tissue that constantly remodels itself in response to several factors, such as mechanical stress and hormonal changes, osteoporosis can be regarded as a consequence of exaggerated bone resorption and/or reduced bone formation, due to unbalanced activity between bone forming cells (osteoblasts) and bone resorbing cells (osteoclasts). Osteoporosis is a chronic multifactorial metabolic disease associated with aging, but with several factors that can contribute to skeletal fragility, including genetics, nutrition, lack of physical activity, smoking, endocrine alterations, and medications. Importantly, osteoporosis is a silent condition, which often manifests itself clinically when bones fracture. Researches in the last decades clearly indicated strategies for prevention, screening, clinical management, and treatment and, thus, novel drugs have been developed to manage osteoporosis, decrease fracture risk and consequent complications. However, gender disparities exist in this context, and for too much time osteoporosis has been considered a female gender disease, so that our knowledge on male osteoporosis is still not complete. Even if in absolute numbers osteoporosis is indeed more frequent in females, males could also be affected during aging or as consequence of different conditions. Male osteoporosis is a neglected condition, under-considered, under-diagnosed, and under-treated. Guidelines on screening politics do not agree whether and when men should be evaluated, and clinical trials are far less performed in men with respect to women. Furthermore, male osteoporosis is more frequent as secondary to other conditions, in contrast to women in which the most common form is primary osteoporosis. Thus, identification of specific causes of male osteoporosis is essential to drive the correct treatment and specific diagnostic procedures are essential in the management of osteoporosis in men.