Aug 2026· Turkish Journal of Medical Sciences· 0 citations
TL;DR
Effective care in cases of male osteoporosis requires an integrated risk-based approach that extends beyond BMD to include clinical risk factors, secondary causes, and functional status, and improved recognition and sex-specific management strategies are essential to reduce the fracture burden and improve long-term outcomes in men.
Abstract
Osteoporosis in men is a common yet underrecognized condition associated with substantial fracture-related morbidity and excess mortality. Although men generally attain higher peak bone mass than women, age-related changes in bone microarchitecture, progressive cortical bone loss, declining sex steroid bioavailability, and a high prevalence of secondary causes contribute to a significant lifetime fracture risk. Importantly, a large proportion of fragility fractures in men occur at bone mineral density (BMD) values above the osteoporotic threshold, highlighting the limitations of BMD-based diagnosis alone. This review provides a comprehensive overview of the epidemiology, pathophysiology, and clinical characteristics of osteoporosis in men, with particular emphasis on sex-specific skeletal aging, hormonal regulation, and secondary osteoporosis. Current strategies for fracture risk assessment are critically examined, including the roles and limitations of dual-energy X-ray absorptiometry, vertebral imaging, the Fracture Risk Assessment Tool, and alternative risk prediction tools. We further summarize evidence-based approaches to management, encompassing lifestyle measures, correction of reversible risk factors, and pharmacological therapies. Antiresorptive agents remain the first-line treatment for most men, while anabolic therapies and sequential treatment strategies are increasingly recognized for those at very high risk of fracture. Overall, effective care in cases of male osteoporosis requires an integrated risk-based approach that extends beyond BMD to include clinical risk factors, secondary causes, and functional status. Improved recognition and sex-specific management strategies are essential to reduce the fracture burden and improve long-term outcomes in men.
A practical clinical framework is proposed that integrates endocrine phenotype, vertebral imaging, trabecular bone score, and biochemical assessment into fracture-risk stratification and therapeutic decision-making, enabling improved identification of high- and very-high-risk patients and facilitating the appropriate use of anabolic and antiresorptive therapies.
I. Cincione, Robert A. Marcantonio, Marcellino Monda et al.· Frontiers in Endocrinology· 0 citations
Low bone density is a significant health concern among perimenopausal women, contributing to increased risk of osteoporosis and fractures. This review synthesizes current evidence from recent articles to elucidate the etiology, risk factors, diagnostic approaches, and management strategies related to low bone density during the perimenopausal period. Hormonal fluctuations, particularly declining estrogen levels, play a pivotal role in bone resorption surpassing formation, leading to decreased bone mineral density (BMD). Additional factors such as nutritional deficiencies, sedentary lifestyle, smoking, excessive alcohol consumption, and genetic predispositions further exacerbate bone loss. Diagnostic tools like dual-energy X-ray absorptiometry (DXA) are essential for early detection. Preventive and therapeutic interventions, including lifestyle modifications, calcium and vitamin D supplementation, and pharmacologic treatments like bisphosphonates, are discussed. Emphasizing early identification and comprehensive management can mitigate long-term skeletal complications, improving quality of life in perimenopausal women. Future research directions focus on personalized treatment approaches and understanding molecular mechanisms underlying bone density changes during this transitional phase.
Runna Bhattacharjee· International Journal For Mu...· 0 citations
Osteoporosis is a systemic skeletal disorder characterized by low bone density and microarchitectural deterioration, both of which lead to increased risk of fracture, disability, institutionalization, and mortality. Dual-energy X-ray absorptiometry (DEXA) remains the gold standard for evaluating bone mineral density and establishing diagnostic thresholds. However, accurate interpretation requires more than the application of numerical cut-offs. Interpretation requires careful evaluation of graphical bands, artifact recognition, awareness of site discordance, and application of least significant change for precise longitudinal assessment. With a structured approach that distinguishes between universal screening from targeted testing, laboratory evaluation further complements imaging by identifying secondary causes. Although bone turnover markers offer additional value in monitoring therapeutic response, their use is limited by assay variability. From an orthopedic perspective, fragility fractures are sentinel events that highlight underlying skeletal fragility. Often the first to encounter these patients, orthopedic surgeons are uniquely positioned to initiate comprehensive evaluation and secondary prevention. This review synthesizes international guidelines and recent literature to provide a practical framework for DEXA interpretation, laboratory integration, and holistic management aimed at reducing refracture risk, improving functional outcomes, and lowering healthcare costs.
J. Lee, Se Lim Kim, G. Kong· Hip & Pelvis· 0 citations
BACKGROUND
Osteoporosis is a silent disease disproportionately affecting women during peri- and postmenopause due to the associated reduction in oestrogen. It incurs a high fragility fracture risk and financial costs to society. General practitioners (GPs) are well placed to detect this, diagnose it and reduce the subsequent burden of disease.
OBJECTIVE
To equip GPs with the understanding of the extent of the disease, pathophysiology and why early detection matters; while further developing screening and diagnostic skills to identify osteoporosis, especially in high-risk women.
DISCUSSION
Osteoporosis is the result of resorption- formation uncoupling driven by oestrogen reduction during menopause. The incidence of osteoporosis is increasing. Screening to prevent fractures is essential, especially where risk factors, with a prior fracture being the biggest risk for future fractures, are present. Diagnosis on dual-energy X-ray absorptiometry (DXA) (although not always Medicare reimbursed) is with T-score ≤-2.5. X-rays can complement the work-up because a fragility fracture substantiates a diagnosis.
S. Sztal-Mazer, C. Goeltom· Australian Journal of Genera...· 0 citations
Osteoporosis, characterized by low bone mineral density (BMD) and increased fracture risk, is common yet underdiagnosed in older adults. Medications such as corticosteroids, levothyroxine, and antiepileptic drugs are well-documented contributors to BMD loss. This study examines how long-term use of these medications affects osteoporosis prevalence, specifically focusing on sex and age differences. This retrospective electronic health record study included adults aged 50-90 years. In the revised primary analysis, osteoporosis was defined using diagnosis codes only; osteoporosis screening codes and DXA procedure codes were excluded from the primary outcome. Associations between chronic exposure to corticosteroids, levothyroxine, or antiepileptics and osteoporosis ascertainment were estimated using modified Poisson regression with robust standard errors, adjusting for demographics, healthcare utilization, medication-specific indication diagnoses, and bone health covariates. Adjusted prevalence ratios and adjusted prevalence differences were reported. In the revised diagnosis-only analysis, associations were attenuated relative to the original broad outcome definition. Chronic corticosteroid exposure retained a positive but imprecise association with osteoporosis ascertainment (aPR 1.57, 95% CI 0.79-3.12; aPD +1.15 percentage points), whereas antiepileptic exposure (aPR 0.92, 95% CI 0.66-1.30; aPD -0.15 percentage points) and levothyroxine exposure (aPR 0.71, 95% CI 0.42-1.21; aPD -0.59 percentage points) were not associated with higher adjusted prevalence. Long-term use of corticosteroids, levothyroxine, or antiepileptics increases osteoporosis risk, with sex- and age-specific patterns. Men, especially younger ones, showed greater relative risk, while women exhibited higher absolute prevalence. These findings support targeted screening and early intervention strategies based on medication exposure, age, and sex.
Matthew Bratton, A. Ulfers, G. Laborde et al.· GeroScience· 0 citations
Osteoporosis is a global health concern with bone frailty and high fracture risk. Existing diagnostic paradigms largely rely on bone scanning and bone mineral density evaluation which are hindered by the delayed prediction of fractures, especially in high-risk groups. This review assesses existing and novel Osteoporosis biomarkers, their mechanisms, clinical efficacy, drawbacks, and discusses the best biomarkers in Osteoporosis risk stratification and management, to convert them into better patient care. An online search was conducted, including PubMed, Web of Science, Embase, and Google Scholar up to June 2026. Passed studies were reviewed critically and organized biomarkers into five different panels: traditional and bone turnover markers, mineral metabolism and endocrine regulators, inflammatory and immune mediators, novel metabolic and multi-omics biomarkers, and combined biomarker panels. The traditional markers are still useful in therapeutic monitoring, although they have a natural biological variability that cannot be used to achieve optimum diagnostic use. Combined and inflammatory mediator panels showed greater discriminative ability, with Net Reclassification Index improvements of 0.15-0.23, appropriately reclassifying 15-23 percent of intermediate-risk patients who were misidentified by traditional screening. The highest performance acquisition was experienced in diabetic cohorts, where density-based measurements often miss. The management of osteoporosis should be changed to precision medicine with multi-dimensional biochemical profiling. The clinical utility and cost-effectiveness of the integrated approach in biomarkers make them a mandatory complement to imaging and a crucial point in holistic patient care for improved prognosis.
Wasan Nori, Mohammed Jaffer Jawad, Munaf Jarallah Yaseen et al.· AL-Kindy College Medical Jou...· 0 citations