Intended for healthcare professionals


Osteoporosis in men: who should we treat?

BMJ 2014; 349 doi: (Published 03 July 2014) Cite this as: BMJ 2014;349:g4229
  1. Juliet Compston, emeritus professor of bone medicine
  1. 1Department of Medicine, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
  1. Correspondence to: jec1001{at}

Protective treatment for men with previous fragility fractures would be a good start

Although osteoporosis is a condition traditionally associated with postmenopausal women, it also causes substantial morbidity and mortality in older men.1 Low rates of diagnosis and treatment in men arise from lack of awareness of the condition and uncertainty about how to identify those who need treatment. Diagnostic criteria for osteoporosis in men based on bone mineral density (BMD) have proved controversial, and consensus is lacking around diagnosis and treatment. In their linked paper (doi:10.1136/bmj.g4120), Ensrud and colleagues explore how the different approaches to diagnosis alter the proportion of older men identified as candidates for treatment.2

The debate around diagnostic criteria for osteoporosis in men hinges on whether reference BMDs from healthy women or men should be used and whether BMD measurements at one site or multiple sites should be considered. Women have lower BMD than men, so a diagnosis based on T scores derived from healthy women requires a lower absolute BMD than one based on T scores derived from healthy men. Furthermore, the less than perfect correlation between BMD measurements at different skeletal sites means that the prevalence of osteoporosis seems to increase with the number of …

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