During youth, bone grows in length and density. During the teen years, maximum height is reached, but bones continue to grow denser until about age 30 when peak bone mass is attained. After that point, bones slowly start to lose density or strength. Throughout life, bone density is affected by heredity, diet, sex hormones, physical activity, lifestyle choices and the use of certain medications.
Most people don't know they have decreased bone density until they get tested or they break a bone. A bone mineral density (BMD) test is the best way to check bone health, since osteoporosis is basically a silent disease.
Osteoporosis causes the skeleton to weaken and the bones to break. It poses a significant threat to more than 2 million men in the United States. One in four men over age 50 will have an osteoporosis-related fracture in their remaining lifetime.
It develops less often in men than in women because men have larger skeletons, their bone loss starts later and progresses more slowly, and they have no period of rapid hormonal changes.
Hypogonadism is widely considered to be an important cause of male osteoporosis, occurring in up to 20% of men with vertebral fractures and 50% with hip fractures.
Testosterone is known to play an important role in the maintenance of the male skeleton; therefore, improving bone density in men with hypogonadal osteoporosis. Testosterone is known to decrease bone resorption and stimulate bone mineralization.
Treatments with calcium plus vitamin D and bisphophonates are widely used in men, when osteoporosis is documented and hypogonadism has been excluded. The poor knowledge on male osteoporosis accounts for the lack of well shared protocols for the clinical management of the disease.
Osteoporosis is a debilitating side effect of testosterone deficiency. It is practical for all men beginning testosterone replacement to receive calcium and vitamin D, and maintain a reasonable exercise regimen. Baseline BMD and follow-up bone density measurements are appropriate with consideration of bisphosphonate treatment as a possibility in those whom osteoporosis develops.