An Overview of Male Osteoporosis

Melissa A. Burmeister, PhD; Timothy K. Fincher, PhD, RPh; Anthony M. Todd, PharmD; Kristopher G. Virga, PhD; Mary M. Maddox, PharmD Candidate 2022


US Pharmacist. 2021;46(6):18-24. 

In This Article

Male Osteoporosis

Several factors related to male osteoporosis have been established. Osteopenia (low bone density) typically manifests in older age, with age-related hypogonadism (in men, testosterone decline) being a primary reason for this.[4] Additionally, osteoporosis often occurs secondary to comorbidities that impair healthy bone turnover.[5] Vitamin and mineral deficiencies related to decreased dietary intake or malabsorption, as well as comorbidities that lead to increased mobilization of calcium from bone or reduced mineralization of bone, also play a role.[5] For instance, vitamin D deficiency and consequent calcium deficiency and secondary hyperparathyroidism can result in substantial bone loss.[6] Of particular relevance to the pharmacist is the fact that male osteoporosis can be induced by a wide array of medications, including aluminum-containing antacids, antiseizure drugs, chemotherapeutic agents, immunosuppressants, androgen-deprivation therapy (ADT), heparin, proton pump inhibitors (PPIs), selective serotonin reuptake inhibitors (SSRIs), corticosteroids, and antidiabetic drugs (thiazolidinediones [TZDs]); an excess of thyroid hormone (TH) also can cause it.[7–18] It should also be kept in mind that men with a family history of osteoporosis are predisposed to developing this condition.[19]

Men are less likely than women to undergo routine screening. They are also less likely to receive treatment following a low-trauma fracture, which increases their risk of sustaining subsequent fractures.

Bone health is primarily ascertained by a bone mineral density (BMD) test. Men, however, are less likely than women to undergo routine screening.[20] They are also less likely to receive treatment following a low-trauma fracture, which increases their risk of sustaining subsequent fractures, and low treatment rates persist even after a high-trauma fracture involving the hip.[20] The importance of heightened vigilance in identifying risk factors and clinically diagnosing osteoporosis in men is underscored by morbidity and mortality data showing that although comparatively fewer men develop the disorder, they are more likely to die within a year of fracturing a hip.[21]

The pharmacist can work to improve patient outcomes by fostering increased awareness of osteoporosis prevalence in older men; advocating for bone-health screening in individuals who are at increased risk; providing useful information on effective measures for maintaining healthy bone; and facilitating the management of osteoporosis upon diagnosis. In addition to a discussion of standard pharmacotherapy, the pharmacist should counsel on the benefits of lifestyle modifications, such as consuming a diet rich in calcium and vitamin D, performing resistance exercises (weight-bearing or strength-training), refraining from smoking and alcohol consumption, and practicing fall-prevention strategies, for reducing risk and counteracting bone loss.[22]