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

Diagnosis and Classification

Dual-energy x-ray absorptiometry (DEXA) scanning of the hip and spine is the gold standard for diagnosing BMD. DEXA scores are typically reported as T-scores and Z-scores.[30] The T-score compares the patient's BMD with that of a healthy 30-year-old of the same sex, whereas the Z-score compares it with that of an average person of identical age and sex.[30] World Health Organization guidelines classify a patient's BMD according to four diagnostic categories based on T-score relative to the reference mean BMD and T-score for young adults: 1) normal bone mass (BMD within 1 standard deviation [SD]); 2) low bone mass (BMD >1.0-<2.5 SDs below); 3) osteoporosis (BMD 2.5 or more SDs below); and 4) severe or established osteoporosis (BMD >2.5 SDs below in the presence of 1 or more fractures).[5] BMD tests are commonly combined with more cost-effective, questionnaire-based risk-assessment tools such as the Fracture Risk Assessment Tool (FRAX) and QFracture.[31] These calculation tools determine fracture risk via algorithms that factor several clinical-risk variables, including age, sex, weight, height, BMD, previous fracture history, family history of hip fracture, tobacco and alcohol intake, presence of rheumatoid arthritis, and secondary conditions related to osteoporosis.[32]

In addition to BMD testing, the following are key diagnostic tools for assessing risk: serum levels of 25-hydroxyvitamin D, calcium, TH, parathyroid hormone (PTH), and testosterone and bone-turnover markers (bone formation: bone-specific alkaline phosphatase, osteocalcin; bone resorption: telopeptides of type 1 collagen).[33,34]

According to the National Osteoporosis Foundation, male patients with a previous hip or vertebral fracture (clinical or asymptomatic) or a T-score −2.5 or less at the femoral neck, total hip, or lumbar spine should be offered treatment for osteoporosis regardless of age. Men should also be treated if they are aged 50 years or older and have low bone mass (T-score between −1 and −2.5 at femoral neck, total hip, or lumbar spine and a 10-year hip-fracture probability of 3% or more or 10-year major osteoporotic fracture [spine, hip, forearm, humerus] probability of 20% or more per FRAX).[35]