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Osteoporosis in men

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Updated 2024 ESCEO guidelines for the diagnosis and management of osteoporosis in men.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of osteoporosis in men are prepared by our editorial team based on guidelines from the American College of Physicians (ACP 2024), the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO 2024), the Osteoporosis Canada (OC 2023), the European Academy of Andrology (EAA 2018), the U.S. ...
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Diagnostic investigations

History and physical examination: as per ESCEO 2024 guidelines, use the FRAX tool for the assessment of fracture risk and as the basis for setting intervention age-dependent thresholds in male patients with osteoporosis.
A
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  • Bone mineral density testing (indications)

  • Bone mineral density testing (technical considerations)

  • Evaluation of secondary causes

  • Evaluation for fractures

Medical management

Indications for treatment: as per ESCEO 2024 guidelines, consider initiating pharmacotherapy in all male patients with a history of fragility fracture.
B
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  • Antiresorptive therapy (bisphosphonates)

  • Antiresorptive therapy (denosumab)

  • Anabolic therapy

Nonpharmacologic interventions

Lifestyle modifications
As per ES 2012 guidelines:
Advise smoking cessation in males at risk of osteoporosis.
B
Consider advising to reduce alcohol intake in males at risk of osteoporosis consuming ≥ 3 units of alcohol per day.
C

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  • Physical activity

  • Calcium and vitamin D supplementation

  • Other supplements

Specific circumstances

Patients with hypogonadism, clinical assessment: as per EAA 2018 guidelines, consider calculating the FRAX score in all patients with confirmed hypogonadism.
C

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  • Patients with hypogonadism (bone mineral density testing)

  • Patients with hypogonadism (laboratory testing)

  • Patients with hypogonadism (X-ray)

  • Patients with hypogonadism (lifestyle modifications)

  • Patients with hypogonadism (calcium and vitamin D supplementation)

  • Patients with hypogonadism (testosterone therapy)

  • Patients with hypogonadism (antiresorptive therapy)

  • Patients receiving androgen deprivation therapy

Preventative measures

Calcium and vitamin D supplementation: as per USPSTF 2018 guidelines, insufficient evidence to assess the balance of benefits and harms of vitamin D and calcium supplementation, alone or combined, for the primary prevention of fractures in males.
I

Follow-up and surveillance

Indications for referral: as per OC 2023 guidelines, consult with a healthcare professional with expertise in osteoporosis (such as a family physician, general internist, endocrinologist, rheumatologist, or geriatrician) when uncertainty exists about fracture risk or treatment, such as possible secondary causes of osteoporosis, comorbidities complicating management, and important adverse effects from pharmacotherapy.
E

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  • Assessment of treatment response

  • Follow-up