Male osteoporosis: delay in diagnosis, increased risk of fractures and post-fracture mortality

Abstract

Background. Osteoporosis in men is frequently underdiagnosed and undertreated, although it has a major clinical impact, with severe fractures and increased mortality. The etiology is often secondary, and hormonal deficiency plays a central role. Late recognition leads to delayed diagnosis and treatment. Objective(s). Comparison of clinical, hormonal and therapeutic characteristics of osteoporosis in men and women, highlighting male particularities, secondary etiologies and undertreatment. Materials and methods. A total of 232 patients diagnosed with osteoporosis, according to DEXA criteria (T-score ≤ -2.5) and/or the presence of fragility fractures, were included. The group included 112 men and 120 women, with average ages (67–68 years). Hormonal data, comorbidities, fracture types and treatments were analyzed, with a focus on gender differences. Results. Men accounted for 48.3% of the cohort and were diagnosed, on average, 7 years later than women. Vertebral fractures were the most common (46%), followed by hip fractures (25%), with one-year post-hip fracture mortality being higher in men (22% vs. 13%). A total of 60% of men had testosterone levels <300 ng/dL, and 43% also had estradiol levels <15 pg/mL. A positive correlation was observed between T-score and estradiol (r = 0.41). Secondary causes were identified in 56% of men, including corticosteroid therapy, liver/kidney disease, and hypogonadism. Nevertheless, only 31% of men received specific treatment, compared to 68% of women. Conclusion(s). Osteoporosis in men is often underdiagnosed and treated late, being linked to a higher rate of severe fractures and increased post-fracture mortality. Hormonal deficiency plays a key pathogenetic role, and the prevalence of secondary causes justifies thorough evaluation and personalized care.