Fracture prevention in men.

The lifetime risk of experiencing a fracture in 50-year-old men is lower (20%) than the risk in women (50%). Consequently, much less research has been carried out on osteoporosis and fracture risk in men. Differences in the risk and incidence of fractures between men and women are related to differences in bone-related and fall-related factors between the sexes. During the past decade, progress has been achieved in case finding and fracture prevention in men. Epidemiology studies have better specified the prevalence and incidence of fractures, and insight into the pathophysiology of osteoporosis and fractures in men has progressed considerably. Case finding for men and women at the highest risk of fracture is now possible using the FRAX algorithm, which includes clinical risk factors, with and without bone mineral density, and allows calculation of an individual's 10-year fracture risk. Although strategies to prevent fractures are much less common in men than in women, several treatment options are now available for this purpose. Bisphosphonates, in particular, consistently demonstrate a positive effect on bone mineral density, and some data also indicate decreased rates of vertebral fractures. For men with severe osteoporosis, treatment with the anabolic agent teriparatide might be an effective option.