Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy.
Andrology. 2018 Mar;6(2):272-285. doi: 10.1111/andr.12470. Epub 2018 Mar 2.
Male osteoporosis is now a well-recognized medical disorder with established clinical guidelines for both diagnosis and management. Prevention as well as management of osteoporosis in men consulting the andrological outpatient clinic because of low testosterone, however, is not well established. This gap of knowledge is-at least partly-explained by the controversy with respect to the threshold of testosterone needed for skeletal maintenance. However, testosterone deficiency may be clearly associated with bone loss as well as frailty in men. If anything, andrologists should therefore be aware of the potential silent presence of osteoporosis in men with confirmed hypogonadism. Therefore, the management of patients with potential hypogonadism should include a complete bone health assessment, besides clinical and biochemical evaluation of gonadal status. Such bone health assessment should include specific items in medical history and physical examination related to fracture risk. Furthermore, dual-energy absorptiometry is indicated to evaluate fracture risk in men with confirmed clinical hypogonadism. Regarding treatment, besides general measures to prevent or manage male osteoporosis testosterone replacement can be initiated (as described in guidelines for hypogonadism), but data on its efficacy in preventing fractures are lacking. Thus, additional anti-osteoporotic may be needed, especially in men with very low testosterone who are at high risk of bone loss and/or in men not able to receive testosterone replacement.
男性骨质疏松症现在是一种公认的医学疾病，已经有了明确的临床诊断和管理指南。然而，由于睾酮水平低而到男科门诊就诊的男性的骨质疏松症的预防和管理尚未得到很好的建立。这种知识上的差距至少部分可以用维持骨骼所需的睾酮阈值的争议来解释。然而，睾酮缺乏症可能与男性的骨丢失和虚弱明显相关。如果有的话，因此男科医生应该意识到在确诊性腺功能减退症的男性中，骨质疏松症可能是沉默存在的。因此，对有潜在性腺功能减退症的患者的管理应包括全面的骨骼健康评估，除了对性腺状态的临床和生化评估。这种骨骼健康评估应包括与骨折风险相关的病史和体格检查中的特定项目。此外，双能吸收法用于评估确诊临床性腺功能减退症男性的骨折风险。关于治疗，除了预防或管理男性骨质疏松症的一般措施外，还可以开始进行睾酮替代治疗（如性腺功能减退症指南所述），但缺乏其预防骨折疗效的数据。因此，可能需要额外的抗骨质疏松药物，尤其是在睾酮水平非常低且有骨丢失高风险的男性，或不能接受睾酮替代治疗的男性。
