DOI: https://doi.org/10.22141/1608-1706.5.19.2018.146639

Osteoporosis in men: state of the problem, risk factors, diagnosis, modern approaches to treatment

I.Yu. Golovach, Ye.D. Yehudina

Abstract


Osteoporosis (OP) in men is a heterogeneous disease that has received little attention. Traditionally, OP was considered a di­sease affecting only women. The developed attitude towards male OP as a rare pathology and the lack of alertness lead to the fact that many patients remain untreated. However, one third of the worldwide hip fractures occur in the male population, which results in a high level of disability and premature mortality. The problem of diagnosis and treatment of OP in recent years is becoming increasingly relevant in connection with the population ageing and those complications that are typical for this disease. The frequency of OP-associated fractures in men is similar to the frequency of myocardial infarction and is superior to the incidence of lung carcinoma and prostate cancer. Outcome for male patients after a hip fracture looks frustrating: one third (32 %) dies during the first year after the hip fracture, and only 21 % are able to live independently in society for one year after the fracture. This problem is most common in people over 70 years old. The etiology of male OP can be idiopathic or secondary due to hypogonadism, vitamin D deficiency and inadequate calcium intake, hormonal treatment of prostate cancer, concomitant pathologies, the use of drugs that affect the bone metabolism. In the present review, based on the European and American current guidelines, the issues of male OP epidemiology, the main principles of the disease diagnosis are reviewed, based on the evaluation data of clinical mani-festations, anamnesis information, including targeted screening. The algorithm FRAX application allows patients to start treatment at a stage when bone mineral density is within the range of osteopenic values and there are additional risk factors. Methods of instrumental and laboratory examination of patients are described in detail. The main methods of treatment are highlighted, first-line drug for the treatment of males are bisphosphonates (alendronate, risedronate, zoledronic acid) and teriparatide, the second line is denosumab. Despite the fact that the evidence base for these drugs is precisely small in men, modern data do not suggest gender differences in treatment outcome with similar values of bone mineral density. All these agents inhibit bone resorption, with the exception of teriparatide, which promotes a new bone growth. Timely diagnosis and prophylaxis of OP in men may contribute to early detection, will allow the initiation of the adequate therapy and reduce the number of fractures in such patients.


Keywords


male osteoporosis; risk factors; diagnosis; treatment

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