Management of Osteoporosis in Men: A Narrative Review.

Up to 40% of overall osteoporotic fractures affect men, despite women having a significantly higher prevalence of osteoporosis.

• Women have a significantly higher prevalence of osteoporosis than men.
• Despite lower prevalence, men account for up to 40% of all osteoporotic fractures.
• Male osteoporosis is described as 'still largely underdiagnosed' with bone fragility remaining undertreated.

Hip fractures in males are associated with increased morbidity and mortality compared to women, with mortality approximately twice the rate seen in women.

• Male fractures occur about 10 years later in life than in women.
• Due to advanced age at fracture, men may have more comorbidities.
• Mortality following fractures in men is 'about twice the rate in women.'
• The higher fracture-related mortality in men makes treatment 'of the utmost importance in clinical practice, as it may impact on mortality even more than in women.'

Gender differences in bone geometry beginning during puberty lead to wider bones in males compared to females.

• These gender differences begin during puberty.
• Men develop wider bones than women as a result of these developmental differences.
• Follicle-stimulating hormones, testosterone, estrogens, and sex hormone-binding levels interact with genetic factors to determine peak bone mass, BMD maintenance, and lifetime decrease in men.

Men are more frequently affected by secondary osteoporosis compared to women.

• The higher rate of secondary osteoporosis in men necessitates a complete clinical history and careful physical examination in all osteoporotic men.
• Clinical evaluation should seek clues of possible underlying diseases to guide laboratory testing.
• The review emphasizes the need to identify secondary causes as part of standard workup in male osteoporosis.

Low screening frequency and controversies in BMD testing standards contribute to underdiagnosis and undertreatment of male osteoporosis.

• Bone mineral density (BMD) testing standards remain controversial for men.
• Low screening frequency is identified as a primary reason for undertreatment.
• These diagnostic gaps are described as major barriers to adequate management of male osteoporosis.

Current pharmacological therapy for male osteoporosis includes aminobisphosphonates, denosumab, and teriparatide, with testosterone replacement therapy available for hypogonadal patients.

• Three main drug classes are approved for male osteoporosis: aminobisphosphonates, denosumab, and teriparatide.
• Hypogonadal patients specifically may be treated with testosterone replacement therapy.
• The review is described as a narrative review of management strategies.