Pathogenetic and diagnostic features of osteoporosis in men

Osteoporosis has traditionally been perceived by clinicians as a disease predominantly affecting women. However, contemporary epidemiological data indicate that its prevalence among men is substantially underestimated, particularly in the Russian Federation. Epidemiological studies show that approximately one in five men aged 50 years and older will sustain at least one osteoporotic fracture during their remaining lifetime. The etiology of osteoporosis in men is multifactorial, and a key role is played by genetic factors, reduced testosterone levels, and various comorbid conditions. Notably, the proportion of secondary osteoporosis attributable to underlying diseases or medication exposure ranges from 50% to 80%. Nevertheless, in the Russian population, secondary osteoporosis has been diagnosed in only 17% of men, suggesting insufficient or ineffective evaluation of male patients with osteoporosis for secondary causes. The diagnosis of osteoporosis in men, as in women, is based on bone mineral density assessment by densitometry and fracture risk estimation using the FRAX (Fracture Risk Assessment Tool) calculator, with universal application of diagnostic criteria originally developed for female populations. Despite the widespread adoption of this approach, its clinical validity in men older than 50 years has not been convincingly established.

This review substantiates the need to implement a dedicated diagnostic algorithm for men, incorporating systematic evaluation for secondary causes of osteoporosis, thereby enabling personalized and etiologically targeted therapy to improve clinical outcomes.