Osteoporosis in men and women.

Osteoporosis is a cause of significant morbidity and mortality in postmenopausal women as well as men. In both men and women, increasing age and low bone mineral density (BMD) are the 2 most important independent risk factors for an initial vertebral or nonvertebral fracture. Although the prevalence of osteoporosis is greater in women, mortality after fracture is higher among men. In both men and women, the incidence of vertebral fracture increases with age, although the increase is more marked in women than in men. The diagnostic criteria for postmenopausal osteoporosis in women are well established; however, there is ongoing debate about the appropriate T-scores and BMD thresholds to diagnose osteoporosis in men. Alendronate and risedronate are considered first-line therapy for the treatment of both postmenopausal osteoporosis and male osteoporosis. The efficacy and safety of these agents have been evaluated extensively in randomized clinical trials. Studies suggest that these agents are similarly efficacious in men and women. The anabolic agent teriparatide may also be used to treat men with osteoporosis at high risk for fracture. Studies suggest that treatment with an anabolic agent like teriparatide should be followed by an antiresorptive agent.