Overall Approach to the Evaluation and Treatment of Osteoporosis in Men

This chapter intends to integrate the information concerning many of the factors concerning clinical evaluation of osteoporosis in men and the process of therapeutic intervention in a way that yields a current approach for use in clinical situations. Unfortunately, guidelines for efficient, cost-effective evaluations of patients having, or suspected of having, osteoporosis are poorly validated for either sex. Current practice is based on existing knowledge of the epidemiology and clinical characteristics of osteoporosis rather than upon models that have been carefully tested in prospective studies. Nevertheless, the information available concerning men has expanded considerably in the last decade and allows the formulation of a reasonable approach. Bone mineral density (BMD) is highly predictive of fracture risk in men and, in patients who have experienced fracture or who have conditions associated with low BMD, the measurement of BMD should be strongly considered. As above, clinical judgment is needed to make a decision to measure bone density in men with the conditions not so clearly related to fracture risk. In these situations, BMD measurements can be useful in several ways, including contributing to the diagnosis of skeletal fragility, gauging its severity and guiding decisions concerning therapy. Therefore, bone mineral density measurements have become a common part of the evaluation of fracture risk in men, but there are a number of challenging issues that still confront the choice and interpretation of those measures.