D'Arcy Little, MD, CCFP, Director of Medical Education, York Community Services, Toronto and Academic Fellow, Department of Family and Community Medicine, University of Toronto, Toronto, ON.
Osteoporosis is a common, serious disease in older adults. Until recently, osteoporosis research and treatment have focussed on postmenopausal women. Recently, however, the epidemiology of this condition in elderly men has become clearer and it is evident that osteoporosis is also prevalent in this population. In fact, men over the age of 50 years have a 19-25% lifetime risk of an osteoporotic fracture, as compared to women who have a 50% lifetime risk. In addition, it is estimated that 30% of hip fractures that occur worldwide occur in men, and lead to significant mortality and loss of independence. Indeed, post-hip fracture, men have a higher mortality rate than do women.1,2,3,4 The role of androgens in bone physiology has suggested that testosterone may be one arm in the treatment regimen. The following article will review the place of testosterone in the management of osteoporosis in males.
Bone Physiology and Pathophysiology
Osteoporosis is a "disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture incidence."5 The origin of idiopathic osteoporosis lies in the aging process and normal bone physiology.