Male Osteoporosis

Summary

Male osteoporosis is common and results in considerable morbidity and mortality. There are distinct differences in the normal aging of bone between the genders, which result in a lower fracture rate in men. Men who suffer from osteoporosis are much more likely than women to have secondary causes. The identification and treatment of these secondary causes, wherever possible, will result in substantial improvements in BMD. There is now evidence for use of many of the existing agents to treat osteoporosis in men. In younger hypogonadal men testosterone replacement is worth considering, but in older men especially the over sixties this is less effective and there is an increased risk of adverse cardiovascular and prostatic outcomes. Prostate cancer is an increasingly common cause, which is partially the result of the success of ADT. There is now good evidence for the use of bisphosphonates and denosumab in this group of patients. HIV, whilst not being specific to men, is an increasingly recognised cause of male osteoporosis. The reasons for this are multifactorial and some may well be attributable to the anti-retroviral therapy itself. There is emerging evidence of an increased fracture risk in HIV infected individuals. The bone loss can be prevented by the use of bisphosphonates.

Zusammenfassung

Osteoporose beim Mann ist häufig und resultiert in beträchtlicher Morbidität und Mortalität. Es bestehen ausgeprägte Unterschiede in den normalen Alterungsprozessen des Knochens zwischen Männern und Frauen, welche zu einer niedrigeren Frakturrate bei Männern führt. Bei Männern, die an Osteoporose leiden, liegen deutlich häufiger sekundäre Ursachen vor als bei Frauen. Die Diagnose und Behandlung dieser sekundären Ursachen führen zu einer deutlichen Besserung der Knochendichte. Es liegen inzwischen gute Studiendaten vor, die den Gebrauch gängiger Osteoporosemedikamente auch zur Behandlung von Osteoporose bei Männern unterstützen. Bei jüngeren hypogonadalen Männern sollte eine Testosteron-Substitutionsbehandlung erwogen werden, aber bei älteren Männern, insbesondere bei Männern über 60 Jahre, ist diese weniger effektiv und es besteht ein erhöhtes Risiko für Herz-Kreislauf- und Prostata-Erkrankungen. Prostatakrebs ist eine immer häufigere Ursache für Osteoporose beim Mann, welche zum Teil auf den erfolgreichen Einsatz der Antiandrogentherapie zurückzuführen ist. Wissenschaftliche Daten unterstützen die Anwendung von Bisphosphonaten und Denosumab in dieser Patientengruppe. HIV, wenn auch nicht spezifisch nur bei Männern, wird zunehmend als Ursache von Osteoporose bei Männern anerkannt. Die Gründe hierfür sind multifaktoriell und können zum Teil der antiretroviralen Therapie zugeschrieben werden. Studien deuten daraufhin, dass HIV-infizierte Patienten auch ein höheres Frakturrisiko haben. Diese Knochenverluste können durch Behandlung mit Bisphosphonaten verhindert werden.

Keywords

Male osteoporosis - secondary osteoporosis - bone loss - testosterone

Schlüsselwörter

Osteoporose beim Mann - sekundäre Osteoporose - Knochenverlust - Testosteron

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