This review focuses on the role of testosterone in men on maximizing bone mass and structure, and later in life, helping to maintain its resistance to fracture. The review also includes features of male osteoporosis that differ from those in women.
Evidence is increasing that both androgens and estrogens are important for developing and maintaining optimal male skeletal integrity. Bone mineral density is the best way of predicting fractures, but many qualities of bone issues must be considered. Even though many quality issues cannot be measured clinically, we are aware that osteoporosis and fracture risk are not just a low T-score. We recognize the importance of larger amounts of vitamin D than are usually considered for preventing and treating osteoporosis and osteomalacia and for fall prevention. Androgen deprivation therapy for treatment of prostate cancer, hypogonadism resulting from traumatic brain injury, and diabetes are being recognized as risk factors for osteoporosis and fracture. More information and clearer guidelines exist for screening and treating men with osteoporosis. Still, we are not clear about the proper role of testosterone alone or bisphosphonates alone or combined with testosterone in treating established osteoporosis.
A good deal of information is being accumulated on fundamental and clinical aspects of male osteoporosis. In certain ways, our knowledge has far outpaced our ability to improve patient care.
Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, State University of New York Upstate Medical University, Syracuse, New York, USA
Correspondence to Arnold M Moses, MD, FACE, Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, SUNY Upstate Medical University, Institute for Human Performance, 505 Irving Avenue, Room 1264, Syracuse, NY 13210, USA
Tel: 315 464 9000; fax: 315 464 9011; e-mail: email@example.com