Diagnosis, prevention, and treatment of osteoporosis in men.

Though commonly seen as a disease afflicting only women, osteoporosis affects more than 5 million men in the United States with significant morbidity and mortality. Alcohol abuse, glucocorticoid excess, and hypogonadism are the principle risk factors for osteoporosis in men. Radiographs alone are insufficient in detecting the presence of the disease. Examining bone mineral density is the diagnostic standard used to detect the disease in both men and women. Unfortunately, diagnostic parameters and screening recommendations for bone mineral density testing have not been firmly established in men. The treatment and prevention of osteoporosis has been well studied in women, thus many of the treatments for men with the disease were extrapolated from studies predominantly involving women. Prevention of osteoporosis in men is best directed toward risk-factor modification and supplementation with calcium and vitamin D. The mainstay of treatment is bisphosphonates such as alendronate that have demonstrated both efficacy and safety in studies. Vitamin D and calcium supplementation also has some benefit in treating men with osteoporosis. Parathyroid hormone, thiazide diuretics, and calcitonin may also have a role in the prevention and treatment of osteoporosis in men, although this is not yet firmly established.