Sex and Gender Considerations in Male Patients With Osteoporosis

Abstract

Background Osteoporosis remains underrecognized and undertreated in both men and women, but men who sustain fragility fractures experience greater morbidity and mortality. While men exhibit advanced comorbidity at the time of hip fracture presentation, there are distinct sex-and gender-specific factors related to the pathophysiology and treatment of osteoporosis that further influence morbidity and mortality. Questions/purposes With a selective review of the literature, we evaluated sex-and gender-based differences contributing to increased morbidity and mortality in men with osteoporosis.

Distal Radial Fractures in Older Men

“…The reasons for the discrepancy in osteoporosis evaluation and treatment are unclear but are mirrored in other studies 57 . Our observations support the findings of recent studies following hip fractures, which have shown that men are not being appropriately evaluated for osteoporosis or receiving adequate treatment for low BMD when testing does occur 3,19,22 . Recent literature has shown that a historical bias still exists among physicians and patients with regard to considering osteoporosis a women's disease 58,59 .…”

“…Numerous expert panels agree that women over the age of sixty-five years and those over the age of fifty years who have sustained a fragility fracture should undergo BMD evaluation with dual x-ray absorptiometry (DXA) 19 . Similar guidelines for men have been proposed, with nearly identical recommendations 20 .…”

Possible Association between Erectile Dysfunction and Osteoporosis in Men

“…Women are 3 times more likely to suffer from osteoporosis than men (17.6% vs. 5.2%) (Robert-Koch-Institut, 2011). Male patients with osteoporosis have rarely been the focus of previous studies (Dy et al, 2011). Most studies involving males with osteoporosis have addressed prevalence, life time risk and risk factors for osteoporosis-related fractures (Papaioannou et al, 2009), or results of therapeutic interventions (Amin, 2003).…”

Management of Osteoporotic Patients with Distal Radial Fractures

“…This rate remains unacceptably low despite recent efforts to increase identification and treatment rates for osteoporosis among this at-risk population 97 . Additionally, men are less likely than women to be evaluated and treated for osteoporosis [98][99][100] . Unpublished data from our group from a retrospective study specifically evaluating distal radial fractures showed that men were less likely than women to be evaluated and treated for osteoporosis despite being identified as being at high risk with use of the FRAX tool.…”