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

Risk Factors and Causes

Because men experience worse outcomes following major fracture events and their bone health is not routinely screened, identification of risk factors and recognition of primary and secondary causes of osteoporosis are especially important. Table 1 summarizes risk factors associated with male osteoporosis.[23,24]

On the whole, primary causes of osteoporosis relate to the natural aging process and to inherent risks such as genetic polymorphisms and ethnicity, with non-Hispanic white and Asian individuals being particularly susceptible.[25,26] In women, primary causes are based on age and are classified as either type 1 (also called postmenopausal osteoporosis; usually occurs 15–20 years post menopause) or type 2 (also known as senile osteoporosis; usually develops after age 70 years).[27] In men, however, age 70 years should be used as a benchmark. The comparatively delayed bone loss observed in men versus women is generally due to slower rates of decline for testosterone and estradiol.[4,28] This phenomenon is illustrated by the temporal profile of peak fracture incidence, which occurs approximately 10 years later in males.[24]

Secondary causes of male osteoporosis include sedentary lifestyle, poor nutrition, and medications, along with their associated disease states.[29] Because of their impairment of androgen synthesis, oral glucocorticoids and ADT are of greatest concern.[23] Through various pathophysiological events, many other agents—including TH, TZDs (glitazones, other peroxisome proliferator-activated receptor gamma agonists), antiepileptics, nicotine, SSRIs, anticoagulants, chemotherapeutics, immunosuppressants (e.g., cyclosporin A), and PPIs—induce BMD loss by promoting osteoblast apoptosis, osteoclastogenesis, hypogonadism, renal calcium wasting, decreased intestinal calcium absorption, mineral malabsorption (e.g., magnesium), or vitamin B12 deficiency.[8–18]