Osteoporosis in Men and Women

This chapter explores gender differences in skeletal physiology, epidemiology of osteoporosis, causes of osteoporosis, evaluation of osteoporosis, and treatment of osteoporosis. Osteoporosis is more common amongst women than men. Women have lower peak bone mass, smaller bone size, go through menopause (a period of accelerated bone loss), and have greater longevity when compared to men. The lifetime risk of osteoporotic fracture at any site in women is as high as 40-50%. The morbidity and mortality sustained from fractures and osteoporosis in men does not completely parallel that of women. Men, too, report a distinct decline in quality of life following a vertebral or hip fracture, with 50% failing to regain their independence and mobility. Men also suffer a 25% mortality rate within the year following hip fracture. Current osteoporosis therapies have been well tested in women but variably tested in men, forcing the generalization that most therapies appear to be effective in both genders. Without question, understanding the distinct, gender-specific physiology of bone formation in men and women will lead to therapies that are tailored to address these skeletal differences and improve outcomes.