Osteoporosis in men

Anyone who believed that osteoporosis is a pure female disease is better informed. 20 to 30 percent of patients with osteoporotic fractures are men. Scientists assume that the number of affected men will continue to increase in future due to increasing life expectancy and changing lifestyles. For men, there are still no clearly documented risk characteristics.

However, it can be assumed that the factors that can lead to osteoporosis in men are hardly different from those that cause osteoporosis in women.

Strong risk factors are:

  • Frequent falling or falling (within 6 months two or more times).
  • Past or current fractures that occurred for a minor reason
  • Suspected vertebral fracture, z. B. due to acute persistent strong back pain or body size loss of about 4 cm
  • Underweight (body mass index less than 20) or unwanted loss of more than 10 percent of the original body weight
  • Medicines or other diseases that can lead to osteoporosis:
  • Use of prednisolone 7.5 mg daily or more (or equivalent cortisone preparation) daily for more than 6 months, especially for inflammatory rheumatic diseases
  • Chronic inflammatory bowel disease (Crohn's disease, ulcerative colitis)
  • Disorders of food intake in the digestive tract (malabsorption syndrome: past gastric removal, sprue)
  • Alcoholism, past organ transplantation
  • Hyperfunction of the parathyroid or thyroid
  • Diabetes mellitus type I, severely damaged kidney function
  • Anemia due to vitamin B12 deficiency
  • Taking medication for. For example, phenytoin for epilepsy

Weaker risk factors are:

  • Familial predisposition (relatives with osteoporosis, round back, forearm, vertebral or femoral neck fracture)
  • Inflammatory rheumatic diseases
  • Calcium / vitamin D deficiency
  • Heavy smoking (more than 20 cigarettes daily)
  • Lack of exercise, especially with bed rest, physical disability
  • Testosterone deficiency (male sex hormone): The male hormone testosterone plays a special role. It promotes natural muscle and bone building and helps to keep the skeletal system resilient. If the man is not enough testosterone available, it comes within a few weeks to bone loss (osteoporosis).

It can come to testosterone deficiency:

  • After viral diseases (eg mumps) that damage the testes so that only small amounts of testosterone are produced
  • In dysfunction of the pituitary gland
  • After removal of the testes (for example after prostate cancer)
  • Decreasing testosterone production in old age

Osteoporosis assessment in men

As with women, a careful risk assessment and explanation of the causes must also be carried out for men. If necessary, the testosterone content in the blood is additionally determined in men. Often in men, a bone sample (biopsy) makes sense.

Treatment of osteoporotic men

As a "basic therapy" the adequate administration of calcium / vitamin D as well as muscle building training and fall prophylaxis are indispensable in addition to hormone-substituting or bone-stabilizing medications. For the treatment of male osteoporosis, the highly effective, bone stabilizing bisphosphonates alendronate and risedronate are approved.

If testosterone deficiency is involved in the development of osteoporosis, (in addition) a sex hormone replacement therapy may be considered. This must be discussed in detail by the doctor with the affected person and possibly also with the life partner. Scientific studies have shown that the bisphosphonate alendronate is also effective in men with a history of testosterone deficiency in the development of osteoporosis. For alendronate, the duration of treatment is usually two to three years.

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