Seeman E
Austin and Repatriation Medical Centre, University of Melbourne.
Aust Fam Physician. 1997 Feb;26(2):135-43.
Osteoporotic fractures in men are a neglected public health problem. The pathogenesis of bone loss is incompletely understood but is probably due to reduced bone formation rather than increased bone resorption. Primary or secondary hypogonadism is a common and treatable cause of osteoporosis and should be excluded in all men presenting with spine or hip fractures. Alcohol excess, with or without hypogonadism, is a most important attributable risk factor for osteoporosis in men. There is no known treatment for osteoporosis in men (as there have been no clinical trials using anti fracture efficacy as an endpoint in men) and few well designed trials examining the effects of drugs on bone mineral density (BMD). Bisphosphonates, while reducing fracture rates in women, have only been shown to increase BMD in men Calcium supplementation may slow bone loss. Anabolic agents, such as nandrolone have not been adequately studied. Fluoride therapy cannot be recommended as bone strength does not appear to increase despite the well documented increase in BMD. Risk factors such as alcohol excess and tobacco use should be corrected.
男性骨质疏松性骨折是一个被忽视的公共卫生问题。骨质流失的发病机制尚未完全明了，但可能是由于骨形成减少而非骨吸收增加所致。原发性或继发性性腺功能减退是骨质疏松症常见且可治疗的病因，所有出现脊柱或髋部骨折的男性均应排除该病因。无论有无性腺功能减退，过量饮酒都是男性骨质疏松症最重要的可归因危险因素。目前尚无针对男性骨质疏松症的已知治疗方法（因为尚无将抗骨折疗效作为终点的男性临床试验），且很少有设计良好的试验研究药物对骨密度（BMD）的影响。双膦酸盐虽然可降低女性骨折率，但仅在男性中显示可增加骨密度。补充钙剂可能会减缓骨质流失。合成代谢药物，如诺龙，尚未得到充分研究。尽管有充分记录表明骨密度增加，但由于骨强度似乎并未增加，因此不推荐使用氟化物疗法。应纠正过量饮酒和吸烟等危险因素。
